Detecting Abnormalities: Blood in Stool as a Symptom of Underlying Health Conditions

• Blood in stool, or rectal bleeding, is when blood is passed from the rectum or anus. Blood in stool may be either fresh blood, which is a bright red color, or old blood, which is dark red, brown, or black, and appears either as droplets or spots in the stool, or as black or tarry stools. These different characteristics can be indications of different causes or diseases, such as hemorrhoids, infectious colitis, gastrointestinal bleeding, colorectal polyps or colorectal cancer. 
• If you notice any blood in your stool, make sure to observe the color, appearance, and other associated symptoms so that you can provide this information to a doctor for diagnosis. 
• Because symptoms of hemorrhoids and colorectal cancer are sometimes similar, you should see a doctor to receive a clear differential diagnosis and appropriate treatment. 

Blood in stool, or rectal bleeding, is when blood is passed from the rectum or anus. Blood in stool may be either fresh blood, which is a bright red color, or old blood, which is dark red, brown, or black. The blood can appear either as droplets or spots in the stool, or as black or tarry stools, and with or without pain during a bowel movement. Each of these different characteristics and symptoms can indicate different causes or diseases. As such, if you notice blood in your stool make sure to observe the color, appearance, and other associated symptoms so you can provide this information to a doctor for diagnosis.

Blood in stool can be a symptom of a number of different diseases and does not always point to hemorrhoids. Some diseases that may cause rectal bleeding include:

• Hemorrhoids, which may be accompanied by droplets of blood in the stool during a bowel movement, and may sometimes be accompanied by pain and/or protrusions from the anus.  
• Infectious colitis, which usually presents with diarrhea, watery diarrhea, abdominal pain, and fever.  
• Gastrointestinal bleeding, including upper GI bleeding, accompanied by black, tarry stools with a foul smell; or lower GI bleeding, accompanied by bright red blood mixed with stools. 
• Colorectal polyps, with blood in stools that may come and go. Some colorectal polyps may develop into cancer.  
• Colon  cancer, which, if still in early stages, may not be accompanied by any symptoms. In later stages, however, symptoms may include alternating bouts of constipation and diarrhea, blood in stools, anemia, and abdominal pain. 

Because symptoms of hemorrhoids and colon cancer are sometimes similar, you should see a doctor to receive a clear differential diagnosis and appropriate treatment if you experience any of the following symptoms (remember that colorectal cancer doesn’t only occur in the elderly but in younger patients as well):  

• White mucus being passed with dark blood in stools
• Anemic episodes 
• Frequent, infrequent, or incomplete bowel movements 
• Constant rectal pain
• Alternating bouts of constipation and diarrhea
• Decreasing stool size
• Weight loss
• Family history of colon cancer

Hemorrhoids develop when the blood vessels in and around the anus become swollen or inflamed due to straining or increased pressure. Sometimes a vein becomes so swollen that it cannot shrink back down on its own, causing it to burst, or there may be symptoms of bleeding after a bowel movement, either in the stool or on the tissue when wiping. There may also be pain in some cases, lumps in the anal area, or difficulty with bowel movements.

Hemorrhoids are generally classified into two main types as follows:

1. Internal hemorrhoids, which develop on the inside of the rectum and usually involve swollen blood vessels that are invisible from the outside and unable to be felt by hand. As such, they can only be diagnosed with a colonoscopy. These types of hemorrhoids are classified into 4 distinct stages according to size (from smallest to largest): 
   • First-degree hemorrhoids (stage 1): These are small in size and do not protrude from the rectum at all, although they may cause some bleeding during or after a bowel movement. 
   • Second-degree hemorrhoids (stage 2): These hemorrhoids expand, protruding from the anus during bowel movements before returning to their original position upon completion of a bowel movement. They can also cause more frequent bleeding that is often bright red in color. 
   • Third-degree hemorrhoids (stage 3): Hemorrhoids of this classification are quite large and protrude from the anus during bowel movements and fail to return to their original position without being pushed back in by the patient. These hemorrhoids lead to frequent bleeding and significant irritation. 
   • Fourth-degree hemorrhoids (stage 4): At this stage, hemorrhoids are large and protrude from the anus at all times and cannot be pushed back in, with the distinct possibility of severe pain that disrupts the daily life of the patient. 
2. External hemorrhoids, which develop on the outside of the anus due to the swelling of the blood vessels under the skin in this region. They are visible from the outside and can be felt by hand, and they tend to become more painful when inflamed. 

Some patients may experience both internal and external hemorrhoids simultaneously. 

The treatment of hemorrhoids depends on the symptoms and severity of each individual case and can include the following: 

Non-surgical treatments
This option is used to treat stage 1 and 2 hemorrhoids that are still small in size. There are several non-surgical methods of treatment as follows:

• Suppository medications 
• Injections
• Rubber band ligation

Surgical treatments 
These are suitable for the treatment of external hemorrhoids and stage 3 and 4 internal hemorrhoids. 

• Traditional hemorrhoid surgery
• Stapled hemorrhoidopexy using a PPH stapler
• Laser hemorrhoid surgery
• Doppler-guided hemorrhoid artery ligation with recto-anal repair  

Colon cancer is a malignant tumor that develops in the colon. It is often associated with polyps in the colon and, in some cases, blood mixed in with, or coating, the stool. Some patients may experience symptoms of bloody or dark stools, alternating constipation and diarrhea, loss of appetite, and weight loss. Later and more severe stages of cancer can include colonic obstruction. Patients will experience a change in bowel movement habits, abdominal pain and decreasing stool size.

At present, doctors recommend a colonoscopy for those aged 45 years and above or for those younger than 45 years of age who have abnormal symptoms or are in an at-risk group, such as a family history of cancer or tumors.

A colonoscopy can help to detect the presence of polyps in the colon, which may or may not be associated with cancer. If polyps or other types of abnormal tissue are found, the doctor can perform a biopsy, removing tissue through a scope during the colonoscopy and send it for analysis to determine whether or not they are cancerous. Colon cancer is a type of cancer that can be cured if it is caught early enough. Treatment depends on the stage and type of cancer.   

Rectal bleeding can be prevented by eating high-fiber foods, such as fruits and vegetables, to prevent constipation. You may also consult your doctor about the use of laxatives if you are taking medications that can cause constipation, such as strong painkillers. You should also practice the following:  

• Drink at least 8 cups of water per day
• Avoid caffeine and alcoholic beverages, which will dehydrate the body 
• Have regular bowel movements
• Exercise regularly, which will help stimulate bowel movements
• After going to the bathroom, clean yourself with water or soft toilet paper to prevent friction that can cause wounds and pain