Black Stools and Blood in Bowel Movements: What to Know

Constipation with black stools and some blood streaks?

Hello Doctor, two weeks ago I experienced some constipation, mostly with pellet-like stools, but the stool color was brown.
Occasionally, when I drink more water, the stools are normal and tubular.
I have observed that there are no traces of blood in the toilet water.
Recently, my constipation has become more severe; previously, my bowel movements were once a day to every 2-3 days, but now it’s mostly every 2-3 days.
Therefore, I took over-the-counter enzymes (which claim to contain extracts from rose hips and other ingredients).
After taking them, my first bowel movement was diarrhea, but then it returned to being pellet-like due to insufficient water intake, and I resumed a frequency of about once a day.
Over 90% of my stools are normal pellet-shaped or normal tubular shapes, with a few instances of thin stools, but the last time I went to the bathroom, there was only one thin stool mixed with other normal-shaped stools.
After taking the enzymes for about 1-2 weeks, today, which is when I am asking this question, my constipation is severe.
In the afternoon, I felt the urge to have a bowel movement (I was sure there was stool to expel) and squatted for half an hour without success.
About three hours later, I tried again and spent around half an hour to finally pass stool, but it was black and pellet-like, and when it fell into the water, there were faint streaks of blood, which were bright red.
I am worried this might be a sign of colorectal cancer.
My diet consists mainly of eating out, which is not very healthy, with a lot of processed foods and low vegetable intake.
I exercise regularly, about every two days.
The black stool situation has only occurred once, and I am still observing it.
Three weeks ago, I took licorice cough syrup, but I am unsure if it is related to the black stool.
I have no abdominal pain, and I feel good otherwise.
My bowel movements are clean, and I currently do not have a feeling of urgency or heaviness afterward.
My weight is normal, and I have even gained weight (likely due to eating out).
I would like to ask the doctor what I can do, and if I continue to observe, how long should I wait?

Miss Lin, 20~29 year old female. Ask Date: 2023/05/01

Dr. Xu Kaixi reply Surgery

Blood in the stool is not normal and can have various causes, ranging from hemorrhoids to colorectal tumors.
Based on your description, the source of the blood in your stool is more likely related to internal hemorrhoids caused by constipation.
If you have returned to normal bowel movements but still notice blood in your stool, it is advisable to seek medical evaluation at a hospital.

Reply Date: 2023/05/01

More Info

When it comes to understanding black stools and the presence of blood in bowel movements, it is essential to recognize that these symptoms can indicate various underlying health issues. In your case, the recent changes in your bowel habits, including the appearance of black, granular stools and the presence of bright red blood, warrant careful consideration.

Firstly, black stools, also known as melena, can result from bleeding in the upper gastrointestinal tract. This could be due to several factors, including peptic ulcers, gastritis, or even esophageal varices. The black color is typically due to the digestion of blood as it passes through the intestines, which can give it a tarry appearance. However, you mentioned that your stools were primarily brown and only occasionally appeared black, which may suggest that the black coloration could be due to dietary factors or medications rather than significant bleeding.

The bright red blood you observed in the toilet water is concerning. This type of blood often indicates bleeding from the lower gastrointestinal tract, such as hemorrhoids or anal fissures, rather than a more serious condition like colorectal cancer. However, it is crucial to note that any presence of blood in the stool should be evaluated by a healthcare professional, especially if it persists.

Your history of constipation and the use of over-the-counter enzyme supplements could also play a role in your current symptoms. Constipation can lead to straining during bowel movements, which may cause small tears in the anal area, resulting in bright red blood. Additionally, certain supplements can affect bowel habits and stool consistency, leading to changes in color and texture.

Given your dietary habits, which include a high intake of processed foods and low vegetable consumption, it would be beneficial to improve your diet. Increasing fiber intake through fruits, vegetables, and whole grains can help regulate bowel movements and alleviate constipation. Staying well-hydrated is also crucial, as adequate fluid intake can soften stools and promote regularity.

In terms of monitoring your symptoms, if the black stools and blood persist for more than a few days, or if you experience any additional symptoms such as abdominal pain, weight loss, or changes in appetite, it is essential to seek medical attention. A healthcare provider may recommend diagnostic tests, such as a stool test, endoscopy, or colonoscopy, to determine the cause of your symptoms.

In summary, while the presence of black stools and blood can be alarming, it is essential to consider the context of your overall health, dietary habits, and any accompanying symptoms. Improving your diet, staying hydrated, and monitoring your symptoms closely are crucial steps. If you have any concerns or if symptoms persist, do not hesitate to consult a healthcare professional for a thorough evaluation and appropriate management.

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