Blood in the Stool (Hematochezia)

Having red stool (poop) may not be a cause for concern. It may occur just because you've had red or orange foods. But if you can’t trace it back to something you’ve eaten, don't ignore this sign. See your healthcare provider if you're wondering why your poop is red because red-colored stool may be caused by gastrointestinal bleeding, which can be related to a serious medical issue.

The medical term for visible blood in the stool is hematochezia. The brighter the blood, the more likely it's coming from a source in the lower gastrointestinal tract, such as the colon (large intestine). A darker color may mean the blood is from higher in the gastrointestinal tract (such as the esophagus, stomach, or small intestine).

This article covers the various reasons why you can have red-appearing or bloody stool and how your healthcare provider may diagnose and treat hematochezia.

Symptoms of Hematochezia

Symptoms of hematochezia can vary depending on the cause. If your stool is red due to a food you ate, you may just have visible red stool with no other symptoms.

If your stool is red due to blood from typically minor conditions like hemorrhoids and anal fissures, you may have rectal pain, especially during or after going to the restroom, anal lumps, swelling, and constipation. You also may not see blood in the stool but on the toilet paper after you wipe.

If a more serious condition like colon cancer is the cause of hematochezia, notable symptoms can include rectal pain, abdominal pain, nausea, vomiting, unexplained weight loss, and anemia.

Causes of Hematochezia

Several different types of food with natural or artificial coloring may cause the stool to be red. This can often look like blood, but it isn't. Check food labels because the food might not appear red but may still have red food coloring in it.

Some of the foods that can cause red stools include:

• Red gelatin, popsicles, Gatorade, or Kool-Aid
• Tomato juice or soup
• Large amounts of beets
• Anything colored with red food coloring (red #40)

The most common causes of hematochezia include:

• Hemorrhoids
• Anal fissures
• Diverticular bleeding
• Inflammatory bowel disease

Hemorrhoids

Hemorrhoids are a common cause of bright red blood in the stool or on the toilet paper. A hemorrhoid is actually a form of varicose vein. With hemorrhoids, the veins in and around the rectum and anus become swollen due to causes that include pelvic pressure from pregnancy or weight gain and pushing too hard during bowel movements.

Anal Fissures

An anal fissure is a tear or ulcer (sore) in the lining of the anal canal. The anal canal is the last part of the rectum before the anus. Fissures can occur in anyone but are more common in middle-aged people and infants. They can result from constipation, forcing a hard bowel movement through the anus, and childbirth.

Diverticular Bleeding

A diverticulum is a small pouch in the colon that bulges out of a weakened spot in the colon wall. The condition of having diverticula in the colon is called diverticulosis. Diverticulosis affects about 10% percent of Americans over the age of 40 and about 50% of Americans over 60.

Although not common, diverticulosis may cause bloody stools. This bleeding may not require treatment unless it's continuous or severe. It's not quite understood what causes the condition, but experts propose that age and genetics may play roles.

Inflammatory Bowel Disease

Ulcerative colitis and Crohn's disease are incurable chronic diseases of the gastrointestinal tract. Together, they are known as inflammatory bowel disease (IBD). IBD has active periods (known as "flares") that can cause hematochezia.

It's not specifically known what causes IBD, but it's thought to result from a faulty immune system response. Genetics also appears to be a factor.

What Medications Can Cause Hematochezia?

Non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of stomach ulcers that can cause stomach bleeding that leads to hematochezia. Corticosteroids have also been linked with an increased risk of stomach bleeding that may show up as hematochezia.

These side effects are more common in those over the age of 60, especially when the medications are used for 14 days or more.

How to Treat Hematochezia

Treating hematochezia depends on the cause. For example, for typically minor causes like hemorrhoids and anal fissures, increasing fluids and fiber in your diet (either with foods or a fiber supplement) may be the only remedy recommended by your healthcare provider.

This can keep stool soft and ease constipation to help allow fissures or hemorrhoids to heal.

For bloody stools caused by IBD, a healthcare provider may recommend diet changes and anti-inflammatory medications to control inflammation. In rare cases, surgery may be required to repair or remove parts of the gastrointestinal tract to relieve IBD symptoms.

If a colon polyp or cancer is the cause of hematochezia, the growth will need to be removed. This may be done with a colonoscopy or other surgery.

Are There Tests to Diagnose the Cause of Hematochezia?

Before your healthcare provider can make a diagnosis and offer treatment, they will need to determine the location and cause of the bleeding. They will first ask you questions about your symptoms and medical history.

This includes questions about changes in bowel habits. For example, they will want to know if you've had constipation or diarrhea. They will also want to understand the location of any pain.

In addition, your healthcare provider may perform a rectal exam. They will insert a gloved, lubricated finger into the anus during this exam. Rest assured that this exam is over quickly and shouldn't hurt.

Your healthcare provider may recommend/perform one of these tests:

• A fecal occult blood test (FOBT) checks for blood in the stool. It requires you to collect a stool sample at home. You then drop it off at a healthcare provider's office or a laboratory.
• Blood tests measure specific substances in the blood to see if your immune system is working correctly or diagnose or monitor certain diseases and conditions.
• A colonoscopy examines the rectum and colon using a small scope known as an endoscope. This test is especially used to look for colon polyps and cancer.
• A sigmoidoscopy examines the lower part of your colon, known as the sigmoid colon. It's less invasive than a colonoscopy, as it only examines the lower third of the colon, while a colonoscopy examines the entire colon.
• A gastroscopy, also referred to as an esophagogastroduodenoscopy, uses an endoscope to examine the upper gastrointestinal tract, from the mouth to the stomach. This test looks for abnormalities such as ulcers, cancer, infection, and bleeding.
• A stool culture examines stool to see if pathogens such as bacteria may be causing an infection. Similar to a FOBT, it requires you to collect a stool sample at home and drop it off at a healthcare provider's office or a laboratory.
• A barium swallow, also known as an esophagogram, is a test that looks for abnormalities in the upper gastrointestinal tract using X-rays. Before taking the x-rays, you will drink a liquid containing barium sulfate, which outlines the walls of the esophagus and upper gastrointestinal tract, making it easier to see on X-ray pictures.

When to See a Healthcare Provider

If you notice blood in your stool or on tissue or your clothing, it's important to see your healthcare provider as soon as you can. Although most cases of hematochezia are not caused by serious conditions, the cause of your bleeding cannot be known until your healthcare provider can perform a proper examination.

You should seek immediate medical attention if you experience hematochezia along with fatigue, fever, and/or vomiting, or if there are frequent and/or excessive amounts of blood in your stool.

Summary

Red-colored stools may be the result of the foods you eat or bleeding somewhere in the gastrointestinal tract. When red stools are caused by blood, it's important to determine where the blood is coming from.

Usually, blood in the stool comes from less severe causes like hemorrhoids or anal fissures. However, it can also signify something more concerning, like colon polyps or cancer. Tests ranging from blood tests to imaging procedures may be needed to find the cause.

A Word From Verywell

Blood in the stool is never normal. But it's not always an emergency or a sign of cancer, either. So don't panic: The important thing is to see a healthcare provider as soon as possible to be evaluated.

If you have severe pain, a lot of bleeding, or vomiting along with the blood, get medical attention right away. A healthcare provider can help put the bleeding into perspective and determine if any other tests are needed.