Blood in Stool: Symptoms and When to Seek Medical Help

Blood in the stool?

The patient has a history of internal hemorrhoids and has experienced constipation since childhood, often passing hard stools every 3 to 5 days.
Recently, the patient noticed that the stool was dark brown and hard, with one of the larger stools having a red discoloration on one side.
The red color is not bright red or dark red, and it was only noticeable upon closer inspection, as it appeared different from the smaller stools.
There is no mucus or blood clots present, no blood upon wiping, and no pain.
The toilet water is not stained.
Due to the dark color of the stool, it is unclear whether the red is from blood separation or mixed with the stool.
The patient has a family history of colorectal cancer.
Should this be attributed to internal hemorrhoids, or could it be a sign of cancer? Is immediate medical attention necessary, or can the situation be monitored?

Ms. C, 30~39 year old female. Ask Date: 2020/11/25

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Ms.
C, based on your description, it is difficult to determine whether it is food or actual blood.
You may schedule a routine stool examination at the outpatient clinic.
If there is a positive reaction for occult blood, further tests can be conducted.
Thank you for your inquiry.

Reply Date: 2020/11/25

More Info

When it comes to blood in the stool, it can be a concerning symptom that warrants careful consideration, especially given your history of hemorrhoids and constipation, as well as a family history of colorectal cancer. The presence of dark brown hard stools with a red attachment could indicate a few different possibilities, ranging from benign to more serious conditions.

Understanding the Symptoms
1. Hemorrhoids: Given your history of internal hemorrhoids, it is possible that the red coloration you observed on the stool could be related to hemorrhoidal bleeding. Hemorrhoids can cause bright red blood to appear on the surface of the stool or on toilet paper, but in your case, since the blood is not bright red and there is no pain, it may be less likely to be from hemorrhoids.

2. Constipation: Chronic constipation can lead to the formation of hard stools, which can cause small tears in the anal area (fissures) or exacerbate hemorrhoids, leading to bleeding. The fact that you have been experiencing hard stools and infrequent bowel movements (every 3-5 days) could contribute to this issue.

3. Gastrointestinal Conditions: Other potential causes of blood in the stool can include diverticulosis, inflammatory bowel disease (IBD), or even colorectal polyps or cancer, especially given your family history. The dark brown color of the stool may indicate that the blood has been digested, which can occur with bleeding from higher up in the gastrointestinal tract.

When to Seek Medical Help
Given your symptoms and family history, it is advisable to take the following steps:
- Immediate Consultation: While you may not be experiencing severe symptoms such as pain or significant bleeding, the presence of blood in the stool, especially with a family history of colorectal cancer, should prompt a visit to a healthcare provider. A gastroenterologist can perform a thorough evaluation, which may include a physical examination, blood tests, and possibly imaging studies or a colonoscopy to rule out any serious conditions.

- Monitoring Symptoms: If you choose to monitor your symptoms for a short period, keep an eye on any changes. If you notice an increase in the amount of blood, changes in bowel habits, or the development of new symptoms such as abdominal pain, weight loss, or changes in appetite, seek medical attention promptly.

- Dietary and Lifestyle Changes: In the meantime, consider increasing your fiber intake to help alleviate constipation. Foods rich in fiber, such as fruits, vegetables, and whole grains, can help soften stools and promote regular bowel movements. Staying hydrated is also crucial.

Conclusion
In summary, while it is possible that your symptoms could be related to hemorrhoids or constipation, the presence of blood in the stool, particularly with a family history of colorectal cancer, should not be taken lightly. It is recommended to consult with a healthcare professional for a thorough evaluation and appropriate diagnostic testing. Early detection and intervention are key in managing any potential gastrointestinal issues effectively.

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