Blood in Stool

Blood in the stool can be frightening, whether you discover it while wiping after a bowel
movement or from a test ordered by your health care provider. While blood in stool can
signal a serious problem, it doesn't always. Here's what you need to know about the possible
causes of bloody stools and what you -- and your doctor -- should do if you discover a
problem.

Causes of Blood in Stool

Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the
amount of blood is so small that it can only be detected by a fecal occult test (which checks
for hidden blood in the stool). At other times it may visible on toilet tissue or in the toilet after
abowel movement as bright red blood. Bleeding that happens higher up in the digestive tract
may make stool appear black and tarry.
Possible causes of blood in stool include:
Diverticular disease. Diverticula are small pouches that project from thecolon wall. Usually
diverticula don't cause problems, but sometimes they can bleed or become infected.
Anal fissure . A small cut or tear in the tissue lining the anus similar to the cracks that occur
in chapped lips or a paper cut. Fissures are often caused by passing a large, hard stool and can
be painful.
Colitis . Inflammation of the colon. Among the more common causes are infections
or inflammatory bowel disease.
Angiodysplasia. A condition in which fragile, abnormal blood vessels lead to bleeding.
Peptic ulcers. An open sore in the lining of the stomach or duodenum, the upper end of the
small intestine. Many peptic ulcers are caused by infection with a bacterium
called Helicobacter pylori (H. pylori). Long-term use or high doses of antiinflammatory drugs such as aspirin, ibuprofen, and naproxen can also cause ulcers.
Polyps or cancer . Polyps are benign growths that can grow, bleed, and become
cancerous. Colorectal cancer is the fourth most common cancerin the U.S. It often causes
bleeding that is not noticeable with the nakedeye.
Esophageal problems. Varicose veins of the esophagus or tears in theesophagus can lead to
severe blood loss.

Fecal occult blood (FOB) refers to blood in the feces that is not visibly apparent (unlike other
types of blood in stool such asmelena or hematochezia). A fecal occult blood test (FOBT) checks
for hidden (occult) blood in the stool (feces).[1] Newer tests look for globin, DNA, or other blood
factors including transferrin, while conventional stool guaiac tests look for heme.

Medical uses[edit]
Fecal occult blood testing (FOBT), as its name implies, aims to detect subtle blood loss in
the gastrointestinal tract, anywhere from the mouth to the colon. Positive tests ("positive stool")
may result from either upper gastrointestinal bleeding or lower gastrointestinal bleeding and
warrant further investigation for peptic ulcers or a malignancy (such ascolorectal
cancer or gastric cancer). The test does not directly detect colon cancer but is often used in
clinical screening for that disease, but it can also be used to look for active occult blood loss
in anemia[2] or when there are gastrointestinal symptoms.[3]
The stool guaiac test for hidden (occult) blood in the stool can be done at home or in the doctor's
office, or can be performed on samples submitted to a clinical laboratory. Testing kits are
available at pharmacies in some countries without a prescription, or a health professional may
order a testing kit for use at home. If a home fecal occult blood test detects blood in the stool it is
recommended to see a health professional to arrange further testing. [4]

Source of bleeding[edit]
Gastrointestinal bleeding has many potential sources, and positive results usually result in further
testing for the bleeding site, usually looking for lower gastrointestinal bleedingbefore upper
gastrointestinal bleeding causes unless there are other clinical clues.[5] Colonoscopy is usually
preferred to computerized tomographic colonography.[6]
An estimated 15% of large tested populations have a positive fecal occult blood test. [citation needed] Of
those, about 210% have cancer, while 2030% have adenomas.
A positive test can result from upper gastrointestinal bleeding or lower gastrointestinal bleeding.
The common causes are:

210%: cancer (colorectal cancer, gastric cancer)

2030% adenoma or polyps

Diverticular disease[7]

Haemorrhoids[7]

Inflammatory bowel disease[7]

Angiodysplasia of the colon

Sickle cell anemia

In the event of a positive fecal occult blood test, the next step in the workup is a form of
visualization of the gastrointestinal tract by one of several means:
1. Sigmoidoscopy, an examination of the rectum and lower colon with a lighted instrument
to look for abnormalities, such as polyps.
2. Colonoscopy, a more thorough examination of the rectum and entire colon.
3. Virtual colonoscopy
4. Upper gastrointestinal endoscopy. It is sometimes performed with chromoendoscopy, a
method that assists the endoscopist by enhancing the visual difference between
cancerous and normal tissue, either by marking the abnormally increased DNA content
(toluidine blue) or failing to stain the tumor, possibly due to decreased surface glycogen
on tumor cells(Lugol).[8][9] Infrared fluorescent endoscopy[citation needed] and ultrasonic
endoscopy[citation needed] can interrogate vascular abnormalities such as esophageal varices.
5. Double contrast barium enema: a series of x-rays of the colon and rectum.