Finding blood in the toilet bowl after a bowel movement can be an extremely scary experience. Blood in stool is never a natural occurrence and should always be further investigated to find its cause. Though our first reaction is usually to panic and assume the worst-case scenario, bloody stool is not always an indicator of cancer or other serious disease. It is, however, always an indicator that something unnatural is going on somewhere along the gastrointestinal tract, and it always warrants seeking medical attention to rule out any life-threatening conditions. Seeing your internist or family physician can give you a better idea of what is going on. He or she will perform a rectal examination and ask you several questions about the blood in your bowel movement. Answers to these questions and the results of the physicial exam will help the doctor decide on the next course of action.
Most important, the doctor will ask about the color and volume of the blood loss. Blood in stool is usually either bright red or dark red in color. Bright red indicates that the blood is fresh and has not passed through the GI tract. This indicates that the bleeding originates toward the end of the large intestine, such as the left colon, sigmoid colon, rectum or anal canal. Dark red or maroon blood indicates that the source of bleeding is higher up in the large intestine, such as in the right or transverse colon. Black blood is usually an indicator that the source of bleeding is even higher, such as in the right colon, small intestine or even the stomach. The volume of blood loss is also a significant indicator of what is going on. Small amounts of blood, particularly bright red blood, could be the result of the rupture of internal or external hemorrhoids. Another possible cause of mild loss of bright red blood in stool is anal fissures (tearing of the anal canal lining), which is more common in younger patients. Moderate to severe blood loss, often accompanied by blood clots, is more common in older adults and can be caused by diverticulosis or angiodysplasias. Diverticulosis is the presence of little sacks along the large intestine that could rupture or become infected, leading to blood lost through the rectum or during bowel movement. Angiodysplasias are collections of abnormal, enlarged blood vessels in the colon lining that can bleed when passing stool. Neither of these is life-threatening by itself, but losing a large volume of blood or having an infection is always dangerous, particularly in elderly adults. Any time a large volume of blood is lost or an infection is present, medical attention should be sought immediately, regardless of why it occurred. Blood in stool resulting from polyps or colorectal cancer is usually small in volume and occurs sporadically. The blood can, however, be any color–from bright red to black–since a polyp or tumor can grow just about anywhere along the tract.
If after his or her assessment, your physician has reason to believe the source of bleeding is anything other than anal fissure or hemorrhoids, he or she will refer you to a gastroenterologist. The gastroenterologist is a specialist with many means to pinpoint and treat the source of bleeding. If you are over the age of 50, however, be prepared to undergo a colonoscopy if you present with blood in your bowel movement. Everyone over the age of 50 should have a colonoscopy once every 10 years. If you are over the age of 50 and have experienced bloody stool or rectal bleeding, even once, it is not only in the best interest of your health, but it is absolutely imperative to have the colonoscopy done. Though it may be a rather invasive procedure, the doctor will not only be able to diagnose the exact cause of your bleeding, he or she will most likely be able to remove any and all polyps in your large intestine, regardless of whether they are the source of the bleeding.
