Is Blood in Stool Serious?

Blood in the stool may be an indication of a serious health problem, like bowel cancer. But it’s more likely the result of a minor condition, like hemorrhoids. Only your doctor can say for sure, however.

Blood in the stool (hematochezia) occurs when there is bleeding in the digestive tract. The bleeding often comes from the lower intestine (colon) or rectum and may be noticed when you see blood in the toilet or on toilet paper after wiping following a bowel movement.

Most of the time, blood in the stool is not caused by a serious medical condition but the only way to be certain is to see a doctor to determine the cause.

Symptoms of blood in the stool include: 

• Visible blood in the toilet after a bowel movement
• Visible blood on toilet paper after wiping following a bowel movement
• Red- or maroon-colored stool

Depending on the cause, symptoms that may accompany blood in the stool include:

• Rectal pain
• Rectal itching
• Tissue bulging around the anus
• Sensation of tearing, ripping, or burning pain during or after a bowel movement
• Leakage of stool or difficulty cleaning after a bowel movement
• Diarrhea
• Dizziness
• Fainting
• Palpitations
• Confusion
• Dehydration
• Vomiting

See a doctor for blood in the stool if you also experience: 

• Changes in frequency or consistency bowel movements
• Abdominal pain or cramping
• Weakness 
• Tiredness
• Fever
• Difficulty breathing 
• Weight loss 

Common causes of blood in the stool that are not serious include: 

• Hemorrhoids: swollen blood vessels in the rectum or anus that can cause pain, itching, and sometimes bleeding
• Anal fissure: a tear in the lining of the anus that can cause a sensation of tearing, ripping, or burning pain during or after a bowel movement 

Serious causes of blood in the stool are less common and may include: 

• Precancerous polyps near the end of the large intestine (colon) 
• Colorectal cancer 
  • Blood in the stool may be ignored for years because people may assume it is due to hemorrhoids, only to later be diagnosed with colorectal cancer
  • See a doctor for evaluation of blood in the stool because if colorectal cancer is diagnosed early, it can frequently be treated
• Other causes 
  • Colitis (inflammation of the colon)
  • Proctitis (inflammation of the rectum)
  • Diverticular disease
  • Angioectasias (abnormal blood vessels in the gastrointestinal tract)
  • Rectal ulcers

The cause of blood in the stool is diagnosed with a patient history and physical exam, which usually involves a rectal examination. 

Other tests used diagnose the cause of blood in the stool include:

• Anoscopy to inspect the anal canal and lower rectum
  • This is usually an office procedure that does not require sedation
• Sigmoidoscopy to examine the rectum and most of the lower large intestine
• Colonoscopy to examine the entire colon
• Esophagogastroduodenoscopy (EGD)
• Wireless capsule endoscopy 
• Push enteroscopy
• Double-balloon enteroscopy
• Radionuclide scans
• Barium X-ray
• Angiography
• Nasogastric lavage to help determine if the bleeding is in the upper or lower digestive tract
• Blood tests
  • Complete blood cell (CBC) count
  • Serum electrolyte levels
  • Coagulation profile, including activated partial thromboplastin time (aPTT), prothrombin time (PT), manual platelet count, and bleeding time
  • To check for H. pylori infection

Treatment for blood in the stool depends on the cause. 

• Hemorrhoids
  • Fiber supplements
  • Laxatives 
  • Warm sitz baths 
  • Topical treatments: pain-relieving creams and hydrocortisone rectal suppositories to help temporarily relieve pain, itching, and inflammation
  • Surgery for severe cases
    • Laser, infrared, or bipolar coagulation
    • Rubber band ligation 
    • Sclerotherapy 
• Anal fissure 
  • Fiber therapy
  • Laxatives 
  • Topical nifedipine and topical nitroglycerin 
  • Botulinum toxin 
  • Surgery for cases that persist despite other treatments
    • Lateral internal sphincterotomy
• Precancerous polyps 
  • Surgical removal of polyps (polypectomy)
• Colorectal cancer 
  • Surgery to remove the part of the colon or rectum that has cancer
  • Chemotherapy
  • Radiation therapy
• Colitis 
  • Diet changes
  • Avoiding medications that worsen symptoms including nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Topical medications applied directly to the rectum
    • 5-ASA (aminosalicylic acid or mesalamine)
  • Topical or oral steroid medications 
  • Oral 5-ASA 
  • Biologics: adalimumab (Humira), infliximab (Remicade, Inflectra, Renflexis), and vedolizumab (Entyvio)
  • Intravenous steroids for severe cases
  • Other medications: tofacitinib or cyclosporine