Blood in the stool may have its cause anywhere from the esophagus to the anus. In some cases the blood is only seen as a streak on toilet paper; in others it is bright red blood and obvious. What is very important to know about blood in the stools is the age of presentation and what symptoms the individual is having. Bright red blood in the stools is also known as hematochezia.
In general most causes of bright red blood in the stools are from the lower bowel, but rarely bleeding from the stomach may also present as bright red blood. Blood from the stomach, esophagus usually appears as black in the stools. This is because the blood has mixed and interacted with the various juices and acid of the gastrointestinal tract.
In the younger children, teenagers and adults, blood in the stool may be due to:
- constipation and excessive straining causing a tear in the rectal wall
- ulcer on the rectal area
- necrotizing enterocolitis (seen in neonates)
- inflammatory bowel disease (such as ulcerative colitis)
In the age groups between 40 -70, the cause may be:
- upper gi bleed
Others divide the cause of bright red blood in the stools based on the anatomic site:
Upper GI tract (usually black stools):
- peptic ulcer disease
- bleeding from esophageal varices (varicose veins)
- tear in the esophagus (from forceful vomiting)
- ingestion and tear from foreign body
- vascular abnormality
- ischemic bowel (bowels having no blood)
Lower GI tract (usually bright red, bloody stools):
- anal fissures
- inflammatory bowel disease
- tear from insertion of foreign body
- bowel ischemia
Blood in the stools is never normal. It may be due a benign cause but a malignancy can never be ruled out. Thus, all individuals with blood in the stools should see their physician for further management and evaluation.
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