When Should I See the Doctor for Blood in Stool?

Symptoms that accompany blood in stool that require immediate medical treatment include changes in frequency or consistency of bowel movements, abdominal pain or cramping, weakness, tiredness, and fever.

Blood in the stool often comes from the lower intestine (colon), rectum, or anus and may be noticed when you see blood in the toilet or on toilet paper after wiping following a bowel movement.

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 may 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 include: 

• Precancerous polyps near the end of the large intestine (colon) 
• Colorectal cancer 
  • Blood in the stool may be ignored for years when people assume it is due to hemorrhoids, only to later be diagnosed with colorectal cancer
  • See a doctor to evaluate of blood in the stool because if colorectal cancer is diagnosed early, it can often 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

When to See a Doctor for Rectal Bleeding

See a doctor if you have blood in the stool and along with: 

• Changes in frequency or consistency of bowel movements
• Abdominal pain or cramping
• Weakness 
• Tiredness
• Fever

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
• Confusion
• Fainting
• Dizziness
• Dehydration
• Leakage of stool or difficulty cleaning after a bowel movement

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

• Other rests to help 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
• Wireless capsule endoscopy 
• Push enteroscopy
• Double-balloon enteroscopy
• Radionuclide scans
• Angiography
• Blood tests
  • Complete blood cell (CBC) count
  • Electrolyte levels
  • Coagulation profile

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 
  • Surgery for severe cases
    • Rubber band ligation 
    • Laser, infrared, or bipolar coagulation
    • Sclerotherapy 
• Anal fissure 
  • Fiber therapy
  • Laxatives 
  • Topical nifedipine and topical nitroglycerin 
  • Botulinum toxin 
  • Surgery for cases that persist despite other treatments
• 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
  • Avoid medications that worsen symptoms including nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)
  • 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