Blood in Stool: Possible Causes and What to Do - Gastroenterology and Hepatology

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When you notice blood in your stool, especially if it appears bright red, it can be concerning and warrants further investigation. The presence of fresh blood can indicate several potential issues, ranging from benign to more serious conditions. Here’s a comprehensive overview of possible causes and recommended actions.


Possible Causes of Blood in Stool
1. Hemorrhoids: One of the most common causes of bright red blood in the stool is hemorrhoids. These are swollen veins in the lower rectum or anus that can bleed during bowel movements, often accompanied by pain or discomfort.

2. Anal Fissures: These are small tears in the lining of the anus, usually caused by passing hard stools. They can lead to sharp pain during bowel movements and may also cause bleeding.

3. Diverticular Disease: Diverticulosis involves the formation of small pouches in the colon wall. If these pouches become inflamed or infected (diverticulitis), they can bleed.

4. Colorectal Polyps: These are growths on the inner lining of the colon or rectum. While many polyps are benign, some can develop into cancer over time and may cause bleeding.

5. Colorectal Cancer: Blood in the stool can be a symptom of colorectal cancer, especially if it is accompanied by other symptoms such as changes in bowel habits, weight loss, or abdominal pain.

6. Gastrointestinal Infections: Certain infections can cause inflammation and bleeding in the gastrointestinal tract, leading to blood in the stool.

7. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause inflammation and ulceration in the digestive tract, resulting in blood in the stool.


Recommended Actions
Given that your doctor performed a digital rectal exam and found no abnormalities, it is essential to follow up with further evaluations to determine the cause of the bleeding. Here are some steps you should consider:
1. Consult a Gastroenterologist: A specialist in gastrointestinal disorders can provide a more thorough evaluation. They may recommend additional tests such as a colonoscopy, which allows for direct visualization of the colon and rectum and can help identify any abnormalities.

2. Keep a Symptom Diary: Document any additional symptoms you may experience, such as changes in bowel habits, abdominal pain, or weight loss. This information can be helpful for your doctor.

3. Dietary Adjustments: Ensure you are consuming a high-fiber diet to prevent constipation, which can exacerbate hemorrhoids and anal fissures. Staying hydrated is also crucial.

4. Avoid Straining: If you experience pain during bowel movements, try to avoid straining, as this can worsen hemorrhoids and fissures.

5. Monitor Your Symptoms: If the bleeding persists, increases in volume, or is accompanied by other concerning symptoms (such as severe abdominal pain, fever, or significant changes in bowel habits), seek medical attention promptly.

6. Consider Blood Tests: Your doctor may recommend blood tests to check for anemia, which can occur if there is significant blood loss, and to assess your overall health.


Conclusion
While blood in the stool can be alarming, many causes are treatable. It is essential to take this symptom seriously and pursue further evaluation to determine the underlying cause. Early diagnosis and treatment can significantly improve outcomes, especially for conditions like colorectal cancer or inflammatory bowel disease. Always consult with your healthcare provider for personalized advice and treatment options based on your specific situation.