The first time I saw blood in my stool, I was terrified. It was about two months after I’d been diagnosed with Crohn’s disease, and the doctor had somehow neglected to tell me this could happen. I was certain that something, somewhere, had ruptured, and I was going to die. I called my sister, and had her drive me to the emergency room. I had seen reddish, sort of maroon-colored blood in my stool (which, not uncommon for me, had come out as diarrhea), and I told this to the emergency room doctor. I needed the bathroom again in the middle of our conversation, and the nurse had me collect the fecal matter so they could examine it.
I was next given a colonoscopy, which is an unpleasant test I’ve undergone too frequently. When it was all over, the doctor sat down with me and first assured me that I wasn’t about to die. He explained that probably as a result of the Crohn’s, I had diverticulitis, or small pouches in the wall of my colon (there are other possible causes, but this was mine). The pouches, or diverticuli, can contain blood, and result in blood in the stool. He told me that it didn’t look severe, and would probably heal by itself, but that if I continued to have blood in my stool for more than a couple of days, I should see my doctor, as I might need further treatments. He felt that I didn’t need treatment at that time, so I went home and worried anyway.
Because I always want to know about what is happening inside my body, I looked up “blood in the stool” — that was a very long time ago, so I was looking in medical books, not on the Internet. I learned that there are essentially three types of blood in the stool. Reddish or maroon blood visible in the stool is called hematochezia. The color of this blood in the stool is red because its source is lower in the intestinal tract, usually in the colon, and sometimes in the anal area, so the blood hasn’t been sitting in the intestinal tract for very long. It is usually, for Crohn’s patients, from diverticuli in the colon, although it may be from anal fissures caused by Crohn’s. Although it is rarely serious, it should always be seen by a doctor, who can rule out more serious causes, including colon cancer.
My father died of an intestinal cancer called carcinoid cancer. It was hard to detect at the time he had it, and by the time they did diagnose it, he had lost both a great deal of weight, and a lot of blood, through blood in the explosive diarrhea he was having. This is a very large part of the reason that any time I see blood in my stool, I am terrified; I have always been more afraid than I needed to be — so far, at least. But the history of cancer in your family increases your own chance of getting cancer, so it is something I am always aware of.
About six months after my first bout of blood in my stool, I experienced what is described in medical texts as “black, tarry, and foul-smelling” stool. It was a first for me, and it had been a very painful bowel movement, so again, frightened, I went to the ER (why do these things always happen on weekends?). Again, I was able to provide a sample, and the doctor had me endure a barium enema as well as an upper gastro-intestinal x-ray series, for which you must drink a barium “milk-shake.” (I prefer chocolate, thank you, but was not given the option.) After the tests, I was admitted to the hospital, and after a couple of hours, the gastro-enterologist on call that weekend came to see me. He said that the kind of blood in the stool that I had this time is called melena and it usually comes from higher up in the digestive tract; it can come from the esophagus, a stomach or duodenal ulcer, and a few other causes. Because Crohn’s affects the entire digestive tract, from stomach to anus, it isn’t uncommon to have black blood in the stool; it gets the black color because it has been in the intestinal tract for a long time. He told me that in my case, it was caused by an inflammation of the stomach and duodenal lining, which had bled. This inflammation and resulting black tarry blood in the stool is apparently not uncommon in the early stages of Crohn’s disease. Because my bloodwork had indicated that I was extremely anemic, I was given a pint of blood along with medication. The two medications I was given were an H2 blocker, which works by blocking histamines that would otherwise be producing acid in the stomach and in my case, down into the duodenum (the name for the segment of the digestive tract that joins the stomach to the intestines). Because ulcers may also be caused by bacteria, usually a bacterium called Helicobacter pylori, or H.pylori, I was also given an anti-biotic. This is also not uncommon in Crohn’s disease; because it is to some extent an auto-immune disease, bacterial infections take hold very easily in Crohn’s patients.
The third type of blood in the stool is called occult blood, which means blood that cannot be seen because it is present in such a small amount. The only way to determine if you have occult blood in the stool is through a fecal examination. It may be looked for if you become anemic, or experience a generalized feeling of illness, fatigue, and weakness, and if they cannot find another reason for the loss of blood. I’ve never had occult blood in my stool, to my knowledge.
Many of the causes of visible red blood in the stool, or hematochezia, can be as simple as hemorrhoids, or even little rectal tears from passing large stools; they can also be as serious as colon polyps or colon cancer. Because of that, any time I see red blood in my stool, or even on toilet tissue, I panic. I know how my father died; I am not ready to die the same way. I know it is generally related to Crohn’s, and is usually from diverticulitis or anal fissures, but that doesn’t stop my fear.
The causes of melena, or black, tarry, foul-smelling stool containing blood are generally more severe, if it isn’t false melena. False melena can occur if you have been taking iron supplements, eating black licorice, or taking medications such as Pepto-Bismol TM. True melena can be caused by a bleeding ulcer; gastritis (an inflammation of the lining of the stomach); esophageal varices (dilated veins just under the lining of the esophagus; if they bleed it can be life-threatening); or a tear in the esophagus from vomiting. I had the least frightening cause, and the one most common to Crohn’s patients: a bleeding ulcer. Ulcers, too, can be hereditary, and my father suffered from ulcers during his lifetime. Since that first time, I’ve only had false melena, and because I’ve been aware each time of the cause of it, it wasn’t as frightening to me.
If you have red or black blood in your stool, that means it’s enough blood to be visible, and it could be serious. You should see a doctor as soon as possible. It isn’t, I hope, as terrifying an experience for most people as it is for me; any time I see red blood in my stool, I’m convinced that I’ll be joining my father, soon.
