I Occasionally Poop Blood

Q: I saw a Colorectal Cancer Awareness poster that said to look out for blood in my stools. What exactly am I looking for?

A: A person’s stool (poop) is a window into their health and a precious warning sign of a problem, so look at it before you flush it. Keeping an eye on your stools is an important step in being aware of colorectal cancer and identifying early signs of the disease.

The topic of what one’s stool says about their health is very extensive and I won’t get into it all here, but let’s talk about seeing blood.

Why Am I Bleeding When I Poop

Firstly, blood in your poop is not normal. All blood passed in the stool, around the stool or after the stool is abnormal and represents a problem of varying severity.

Sometimes bleeding may be present but not visible. This is called occult (hidden) blood and may not be discovered until a blood test indicates a low red blood cell count. Rectal Bleeding. Bright red blood in the stool typically indicates that there is bleeding in the rectum or colon, which may be a sign of colon or rectal cancer. Occasionally an ulcer may erode an artery and more rapid bleeding can occur, appearing as bright red blood in the stool. This situation is a medical emergency and will likely be accompanied by symptoms such as light-headedness or even fainting. Common symptoms include blood in stool (pooping blood), a change in bowel habit that lasts for more than 3 weeks, a lump in the stomach area, tiredness, weight loss, and abdominal pain. However, many of these symptoms can be due to a different cause. Blood in your stool is often the result of hemorrhoids, but it can also be a sign of something more serious. The only way to determine this is by seeing your doctor. Don’t be shy about talking about blood in your stool or providing a sample when requested.

So to answer the question, you are just looking for blood. And if you see it, you need to report it to your family physician for investigation. It’s just that simple. Having said that, there are certainly more worrisome characteristics of the blood in one’s stool and certain features that you should be aware of in order to report them to your physician. To understand these characteristics, one must imagine where this blood is coming from.

Colorectal cancer is a disease of the cells of the inner lining of the colon or rectum. The cells begin to grow out of control, first forming a cluster of cells called a polyp and eventually becoming a cancer as the cells burrow deeper into the wall. Because these polyps and eventual cancers are growing on the inner lining of the bowel, they ooze or bleed into the bowel and that blood then becomes incorporated with the stool as it passes through.

With that background, one can begin to imagine just how blood in the stool might look if it is coming from a colorectal cancer. If the cancer is in the right side of the colon (the beginning of the colon and furthest from the anus) then the blood might be undetectable by the eye by the time it reaches the toilet. If there is lots of blood coming from a cancer in the right colon, it may no longer look like red blood by the time it reaches the toilet but rather like black tar mixed in with the stool.

If the cancer is further along in the colon or even in the rectum, the blood will still be red smeared along the stool as it hits the toilet or the blood will be mixed in with the stool but still bright red in appearance.

Finally, if the cancer that is bleeding is in the rectum, just before the exit, you might see only blood coming into the toilet either prior to or after the stool as it is bleeding directly out of the anus rather than mixing with stool.

So by understanding how blood in the stool could be a warning sign of a cancer, it also becomes clearer why we use a fecal immunochemical test (FIT) to look at the stool microscopically (and why it’s so important!) This test checks for occult (hidden) blood in the stool as a screening test for colorectal cancer — it can find blood that isn’t visible to the eye when you look in the toilet.

The test isn’t specific — many other things can lead to hidden blood in the stool and the test can’t tell which it is causing the blood. But it is very sensitive, which means that almost all colorectal cancer patients would be positive if the test was done. That means very few false negatives, which is ideal for a screening test.

It is obviously very important to understand that many different colorectal problems can lead to blood in the stools, not just cancer. But do remember that regardless of the cause, blood in your poop it is not normal and needs discussion and investigation by your primary care physician. The characteristics of the blood will offer clues but by no means will it make a diagnosis and almost certainly the next step will be a colonoscopy to definitively sort out what’s going on.

In very simple terms, please do this for me: Turn and look at your stool before flushing. It could save your life.

(This post was updated in August 2020 to reflect a change in Ontario’s colorectal screening test from the fecal occult blood test to the FIT)

What is gastrointestinal bleeding or blood in the stool?

Spots Of Blood In Poop

The signs of bleeding in the digestive tract depend upon the site and severity of bleeding. If blood is coming from the rectum or the lower colon, bright red blood will coat or mix with the stool. The cause of bleeding may not be serious, but locating the source of bleeding is important. The digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum and anus. Bleeding can come from one or more of these areas — from a small area like an ulcer on the lining of the stomach or from a large surface, such as an inflammation of the colon. Bleeding can sometimes occur without the person noticing it. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.

Symptoms

Symptoms like changes in bowel habits, stool color (to black or red) and consistency and the presence of pain or tenderness may tell the doctor which area of the GI tract is affected. Because the intake of iron, bismuth or foods like beets can give the stool the same appearance as bleeding from the digestive tract, a doctor must test the stool for blood before offering a diagnosis.
Other symptoms:

• Bright red blood coating the stool

• Dark blood mixed with the stool

• Black or tarry stool

• Bright red blood in vomit

• Coffee grounds appearance of vomit

Diagnosis

The site of the bleeding must be located. A complete history and physical examination are essential. A blood count will indicate whether the patient is anemic and also will give an idea of the extent of the bleeding and how chronic it may be.

Endoscopy

Endoscopy is a common diagnostic technique that allows direct viewing of the bleeding site. Because the endoscope can detect lesions and confirm the presence or absence of bleeding, doctors often choose this method to diagnose patients with acute bleeding. In many cases, the doctor can use the endoscope to treat the cause of bleeding as well. The endoscope is a flexible instrument that can be inserted through the mouth or rectum. The instrument allows the doctor to see into the esophagus, stomach, duodenum (esophagoduodenoscopy), colon (colonoscopy) and rectum (sigmoidoscopy); to collect small samples of tissue (biopsies); to take photographs; and to stop the bleeding. Small bowel endoscopy, or enteroscopy, is a procedure using a long endoscope. This endoscope may be used to localize unidentified sources of bleeding in the small intestine.

Other procedures

Several other methods are available to locate the source of bleeding. Barium X-rays, in general, are less accurate than endoscopy in locating bleeding sites. Some drawbacks of barium X-rays are that they may interfere with other diagnostic techniques if used for detecting acute bleeding, they expose the patient to X-rays and they do not offer the capabilities of biopsy or treatment. Another type of X-ray is a CT scan. Angiography is a technique that uses dye to highlight blood vessels. This procedure is most useful in situations when the patient is bleeding acutely, so that dye leaks out of the blood vessel and identifies the site of bleeding. In selected situations, angiography allows injection of medicine into arteries that may stop the bleeding.

Blood Mixed In Poop

Treatment

Endoscopy is the primary diagnostic and therapeutic procedure for most causes of GI bleeding. Active bleeding from the upper GI tract can often be controlled by injecting chemicals directly into a bleeding site with a needle introduced through the endoscope. A physician can also cauterize, or heat treat, a bleeding site and surrounding tissue with a heater probe or electrocoagulation device passed through the endoscope. Laser therapy is useful in certain specialized situations.

Once bleeding is controlled, medication is often prescribed to prevent recurrence of bleeding. Medication is useful primarily for H. pylori, esophagitis, ulcers, infections and irritable bowel disease. Medical treatment of ulcers, including the elimination of H. pylori, to ensure healing and maintenance therapy to prevent ulcer recurrence can also lessen the chance of recurrent bleeding. Removal of polyps with an endoscope can control bleeding from colon polyps. Removal of hemorrhoids by banding or various heat or electrical devices is effective in patients who suffer hemorrhoidal bleeding on a recurrent basis. Endoscopic injection or cautery can be used to treat bleeding sites throughout the lower intestinal tract. Endoscopic techniques do not always control bleeding. Sometimes angiography may be used. However, surgery is often needed to control active, severe or recurrent bleeding when endoscopy is not successful.