Dr. Toshi Is In! "Blood in the stool"

Dear Dr. Toshi,

I noticed blood in my stool. Does that mean I have a hemorrhoid?

Maybe. Maybe not. You may think that blood in stool is from hemorrhoids because you often hear about them, but that's not the only reason you may have blood in your stool. Until you're evaluated by your doctor or provider, no one can say for sure what's causing the blood in the stool.

Blood in stool can be caused by many things. It can come from hemorrhoids as you may have heard, but it can also come from other conditions such as anal fissures (small cracks in the skin around the anus), infections, inflammatory bowel disease (such as ulcerative colitis and Crohn's disease), diverticulosis and diverticulitis, ulcers, gastritis, vascular problems, benign polyps, and colorectal (colon and rectal) cancer, to name a few. The point is that rectal bleeding is not normal.

Even moderate amount of blood from the rectum can lower the amount of blood in your body pretty quickly, causing anemia, and you may notice dizziness, weakness, fainting, and pale skin color if this happens. You may have abdominal pain, too. It's wise not to wait and see, but to see your doctor or other provider right away if you notice blood in your stool.

It's also important to look at your stool to see what it looks like and to notice what symptoms are associated with your bowel movement. This information can give your doctor a lot of important clues. It's helpful if you note your stool's color, hardness or softness, whether it's watery or not, if there's blood mixed in with the stool or is just on the outside of the stool, if it was on the toilet paper when you wiped, or if you saw a lot of blood in the toilet, for instance. Blood that's bright red in color generally comes from somewhere closer to your anus, whereas darker blood comes from somewhere up higher in the GI tract since it's partially digested. So, blood in the stool isn't always bright red. It can be a maroon color or even black and tarry.

By the way, some medications and supplements can also cause black-colored stool, so it's important to tell your doctor or other provider what medications and supplements you're taking.

Blood can come from the upper GI tract, which includes the esophagus, stomach, and the first part of the small intestine called the duodenum. The lower GI tract includes the cecum, colon, rectum, and anus. The rectum is the last 6 inches of the colon. Last week I talked about how long the small intestine is, but it's not as common for blood to come from the small intestine as it is from other parts of the GI tract.

As I mentioned above, colorectal cancer can cause blood in the stool, and it's the third most common cancer in both men and women in the United States. There are several things that can increase your risk of getting colorectal cancer, which you can actually change. (There are also other risk factors that you can't change, such as your age, genetics, and ethnicity, for instance.) The risk factors you can change include your diet, weight, and exercise. A bad diet, being overweight and lack of exercise are strongly linked to the risk of getting any cancer, but certain types of diets raise the risk of colorectal cancer specifically. For example, many studies have shown that a diet high in red meat (beef, pork, lamb, or liver), processed meat (like hot dogs and lunch meat), and cooking meat at high temperatures (frying, broiling, grilling, or charring/blackening) increases the risk of colorectal cancer. Smoking and moderate to heavy alcohol use are linked to an increased risk of colorectal cancer, too.

I hope this article helped you realize that blood in the stool isn't always from hemorrhoids. So, if you see blood in your stool, please make a visit with your doctor or other provider right away.

Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics