Blood in the stools means that something is bleeding in the digestive tract, usually the intestines or rectum. Many conditions that cause gastrointestinal bleeding will also be painful. Intestinal pain is usually accompanied by abdominal pain or tenderness. Rectal problems such as anal fissures can cause bleeding but can also be excruciating. However, some conditions that cause blood in the stools rarely or only sometimes are painful. However, these conditions may have other symptoms like diarrhea, constipation, weight loss, or change in bowel habits.
Blood in the stools, blood floating in the toilet bowl, or blood staining toilet paper can be alarming. Most of the time it’s okay. Some of the time, it’s not okay. Blood in the stools could be an indication of a more serious condition or a severe bleeding problem somewhere in the GI tract.
Blood in the stool is a common symptom that may be caused by lower gastrointestinal conditions such as diverticulosis, colitis, blood vessel problems, colon cancer, inflammatory bowel disease, infection, or medications. Blood in the stools may also be due to rectal bleeding, but most conditions that cause rectal bleeding are usually painful, as well.
Typically, short-lived blood in stool does not require immediate medical attention. If it persists, however, you should contact your healthcare provider.
Treatments of blood in stool with no pain vary by cause but may involve medications, endoscopic procedures, monitoring, and even intensive care, fluid replacement, and blood transfusions if bleeding is too severe. Read more about treatments for diverticulitis, colitis, and hemorrhoids.
Blood in stool with no pain can often be managed with fluid intake, dietary changes, and fiber if the problem is primarily rectal bleeding. Bleeding in the esophagus, stomach, or intestines may require medical intervention.
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Causes of blood in the stool all involve bleeding in the digestive tract. Most cases of painless blood in stool are caused by problems within the lower GI tract: the bottom part of the small intestine, large intestine, rectum, and anus. The upper GI tract may be the cause if the bleeding is particularly heavy.
Diverticular disease is the most common cause of lower GI tract bleeding, accounting for about 40% of cases. Some people form pouches in their colon, a condition called diverticulosis. A diverticular bleed happens when one of those pouches becomes swollen and perforates a small blood vessel, causing bleeding into the bowel. Diverticular bleeding is frequently not painful, but symptoms can include abdominal tenderness or cramping.
Other common causes of lower GI tract bleeding include:
Colitis (20% of lower GI bleeds)
Fragile or abnormal blood vessels, called angiodysplasia (10% of lower GI bleeds)
Colon cancer (3% of lower GI bleeds)
Lack of blood flow to a part of the colon (ischemic colitis)
Infection
Medication side effects, particularly from nonsteroidal anti-inflammatory drugs (NSAIDs)
Side effects of intestinal surgery or radiation treatment
Rectal cancer
All of these conditions are frequently painless, though not always. Hemorrhoids, swollen veins in the rectum, are the second-most common cause of lower gastrointestinal bleeding. Though usually asymptomatic, they are very painful when they become thrombosed (swollen and firm). Most other possible causes of rectal bleeding may be painful. These include rectal sores, anal fissures, or anal fistula.
Inflammatory bowel disease (IBD), either Crohn’s disease or ulcerative colitis, is also a common cause of lower GI bleeding, but pain and abdominal tenderness are common symptoms of IBD.
Colon polyps can bleed into the large intestine, but this is uncommon. Polyps are growths on the colon lining and are typically painless and asymptomatic. When they bleed, they don’t bleed very much or for very long.
Bleeding in the upper GI tract rarely shows up as bright red blood in the stools. Instead, upper GI bleeding usually appears as blood in the vomit or as black, tarry, and smelly stools (melena). This is because stomach acid turns blood into a dark maroon color. Ulcers and GERD-related esophagitis are the most common causes. However, upper abdominal pain is the most common symptom of these two conditions.
However, if bleeding is heavy or is accompanied by watery diarrhea, blood from an upper GI tract can show up in the poop. The most common causes of heavy upper GI bleeding include tears in the esophagus, ruptured esophageal veins (varices), or a large ulcer with a bleeding blood vessel. These are usually life-threatening bleeding emergencies.
RELATED: What does a diverticulitis attack feel like?
Because blood in the stools may be a sign of a more serious condition, visit a healthcare professional to be sure.
About 80% of lower gastrointestinal bleeds will stop spontaneously. That’s the good news. The bad news is that blood in the stool may be due to a potentially serious problem, like cancer, or it can result from massive bleeding, which can even result in death. Massive bleeds in the upper GI tract have a mortality rate of 10% after a person has been hospitalized. Massive bleeding in the lower GI tract has a mortality rate of 4%.
If there is a significant amount of blood in the stool or there are any signs of significant blood loss such as low blood pressure, fast heart rate, or feeling faint when standing or sitting up, go to an emergency room right away.
RELATED: Colon cancer symptoms: what are the early signs of colon cancer?
Diagnosis will require a bit of detective work. The healthcare provider will take a thorough history and perform a physical examination, but stool tests, blood tests, and an endoscopic examination may also be required.
The first order of business is to determine if a significant amount of blood has been lost. That usually involves a blood pressure and heart rate check. If there are signs that blood loss is significant, recovery treatment will need to start immediately.
Most people will initially be seen by a general practitioner or emergency room doctor. Be prepared to answer questions like:
When did you first notice the blood?
Has this happened before?
Are there any other symptoms?
What medical conditions do you have?
Do you have a family history of gastrointestinal problems?
What medications do you take?
What supplements are you taking?
In a physical examination, the doctor will look for clues about what might be bleeding. The doctor may try to find tender spots on the abdomen, feel for masses, or do a rectal examination. Stool tests may be needed, as well as standard blood tests
In some cases, a doctor who specializes in digestive system problems called a gastroenterologist, will perform a colonoscopy or sigmoidoscopy to examine the inside of the colon. An endoscopy may be needed to look for problems in the upper GI tract. A CT scan may be needed if the doctor suspects that blood vessels are actively bleeding.
Blood in the stool is not contagious unless it’s caused by an infection. Most gastrointestinal infections cause symptoms like abdominal pain, diarrhea, and sometimes fever or chills. However, not all infections will cause bleeding or bloody diarrhea. Gastrointestinal infections are caught by ingesting fecal matter, so the best way not to catch a GI tract infection is to practice good hygiene and safe food preparation.
Blood in the stool lasts for as long as the bleeding lasts. Just like cuts on the skin, most bleeding in the digestive system stops in a short time. 80% of lower gastrointestinal bleeding remits spontaneously as any cut or sore on the skin would. Continuous bleeding will usually require medical care and will stop when the wound is closed. Heavy bleeding requires emergency medical treatment.
Most cases of painless blood in the stool remit spontaneously. However, sometimes the bleeding is either due to a serious underlying problem, like cancer, or the bleeding is severe enough to be life-threatening. Unfortunately, no one can tell just by looking at stools in a toilet bowl. If there’s blood in the stools, consider getting treatment. If it doesn’t go away, that means the bleeding is not stopping. At that point, get medical care. If there’s a lot of blood, then emergency medical treatment is needed.
For some people, the blood in the stools treatments consists of being sent home. In these cases, healthcare professionals have determined the problem isn’t serious, and the bleeding is minor and will stop. Others may treat the bleeding in the office through endoscopic or other procedures. Rectal problems like hemorrhoids and skin tags are often treated in the office. Surgery is another treatment option for more serious cases.
If bleeding does not stop or there’s significant blood loss, people may be admitted to an intensive care unit, put on IV fluids, and given medications to promote blood clotting. Severe cases may need blood transfusions.
In the healthcare profession, bleeding is considered one of the most severe and immediate health threats. The first order of business is to stop the bleeding. Bleeding is expected, so almost all of us experience some type of bleeding at some point. However, it’s usually minor and ends reasonably quickly. The same applies to blood in the stools. It’s usually minor and ends fairly shortly. If it doesn’t stop or there’s a lot of blood, see a healthcare professional for a diagnosis, medical advice, and, quite possibly, treatment.
Colon and rectal cancer can sometimes be signaled by stool blood. Stomach cancer bleeding can also sometimes be spotted by black and tarry stools. Colorectal cancer or stomach tumors often don’t bleed enough to produce bloody stools. The bleeding is usually discovered by finding occult blood (“hidden” blood) in a stool test.
Liver or pancreas problems can rarely cause bleeding into the duodenum. Blood that flows into the duodenum is typically chemically altered by stomach acid, so it comes out not as red blood but black and tarry looking.
Dehydration can cause thick, hard stools. Passing hard-to-pass stools can rip small tears or cuts in the rectum so that the stool will be smeared with blood, and the rectum may bleed for a bit. These are typically minor cuts, and they will get better. Are they painless? It depends. They’re undoubtedly uncomfortable, especially when the next bowel movement is due.
Diagnosis of gastrointestinal bleeding: a practical guide for clinicians, World Journal of Gastroenterology Pathophysiology
Gastrointestinal bleeding, StatPearls
Lower gastrointestinal bleeding: evaluation, management, and disposition, emDocs
Gastrointestinal bleeding, StatPearls
Lower gastrointestinal bleeding, StatPearls
Rectal bleeding, StatPearls
Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting, Scandinavian Journal of Gastroenterology
Colitis treatments and medications, SingleCare
Colon cancer treatments and medications, SingleCare
Diverticulitis treatments and medications, SingleCare
Hemorrhoid treatment and medications, SingleCare
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