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Q: What does the presence of blood in my stool and on the toilet paper mean?
A: The presence of bright red blood in the stool is a condition which is referred to as hematochezia. The presence of bright red blood in the stool usually denotes bleeding in the lower gastrointestinal(digestive) tract. This is in contrast to black tarry stools, referred to as melena, and which are a consequence of bleeding in the upper gastrointestinal(digestive) tract. Most of the cases of bleeding in the lower digestive tract are due to bleeding arising from the colon and the anorectal region. Many possible conditions may cause this type of bleeding. In patients under 50 years of age, the most common causes include hemorrhoids
and other possible types of anorectal disease, inflammatory bowel disease, infectious inflammation of the colon, and inflammatory bowel disease. On the other hand, in patients over 50 years of age, common causes include diverticula(outpouchings in the wall of the colon) of the colon, localized widenings of blood vessels in the digestive tract,malignancy, and decreased blood flow to the digestive tract.
Anal and rectal lesions are usually characterized by small amounts of blood on the surface of the stool and toilet tissue. Although this type of bleeding is usually caused by hemorrhoids,
other anorectal conditions, such as anal fissures and fistulas may present in a similar fashion.
Diverticula of the colon are common causes of bleeding in patients over 50 years of age. In addition, polyps, malignant tumors, and other diseases as mentioned above frequently present in this age group with this symptom. To be emphasized, however, is that, for example, any condition can occur at any age. Thus, for example, bleeding may also be due to malignancy in younger individuals.
Work-up of a patient under age 50 which presents with bright red blood per rectum consists in at least performing a sigmoidoscopy in order to evaluate the anal area, rectum, and sigmoid colon. However, in patients over 50 years of age, the entire colon should be examined by means of a colonoscopy. Nuclear bleeding scans and evaluation of the blood vessels of the digestive tract by means of a so called angiogram are only reserved for patients that have persistent amounts of significant bleeding.
Updated: 07/13/99
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