Identifying Blood in Stool: Signs of Colon Cancer and Next Steps

Blood in the stool?

Hello, doctor.
Recently, I have noticed blood streaks on the surface of my stool.
How can I differentiate the blood associated with colorectal cancer? Is it mixed in with the stool? Does the entire stool appear tomato-colored? Or is it just blood on the surface of the stool? When I go to the hospital, will I definitely need a colonoscopy, or is it mostly a digital rectal exam first, and only if necessary will I have a colonoscopy? Thank you.

Xiao Xin, 30~39 year old female. Ask Date: 2011/01/24

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello,
1.
Blood streaks or clots on the surface of stool indicate lower gastrointestinal bleeding, commonly associated with conditions affecting the rectum, anus, or sigmoid colon, such as hemorrhoids, anal fissures, polyps, or tumors, with hemorrhoids being the most frequent cause of bleeding.
Generally, a digital rectal examination, anoscopy (20 cm), or sigmoidoscopy (60 cm) can be performed, and if necessary, a colonoscopy (100 cm) may be conducted.
2.
Currently, colorectal cancer screening involves testing for fecal occult blood, which is not usually visible to the naked eye.
This test detects bleeding that occurs when stool passes over tumors or polyps, causing them to bleed.
If there are frequent blood streaks in the stool, it is recommended to consult a colorectal surgeon or a gastroenterologist.
Wishing you good health,
Dr.
Lin Ming-Hui, Taoyuan Hospital, Department of Health

Reply Date: 2011/01/24

More Info

When it comes to identifying blood in stool and its potential implications for colon cancer, it's essential to understand the different presentations of blood and the appropriate steps to take. Blood in the stool can manifest in various ways, and its appearance can provide clues about the underlying cause.

1. Appearance of Blood in Stool: Blood in stool can appear in several forms:
- Bright Red Blood: This usually indicates bleeding from the lower gastrointestinal tract, such as the rectum or anus. It may be seen on the surface of the stool or on toilet paper after wiping. This is often associated with conditions like hemorrhoids or anal fissures.

- Dark Red or Maroon Blood: This may suggest bleeding from higher up in the colon, such as the sigmoid colon or descending colon. It can sometimes mix with the stool, giving it a darker appearance.

- Black, Tarry Stool: This indicates bleeding from the upper gastrointestinal tract, such as the stomach or duodenum. The blood is digested, giving it a characteristic black color.

2. Colon Cancer and Blood in Stool: While the presence of blood in the stool can be alarming, it is not exclusively indicative of colon cancer. Conditions such as diverticulitis, inflammatory bowel disease (IBD), and benign polyps can also cause blood in the stool. However, colon cancer can present with blood in the stool, especially if there is a tumor that is bleeding.
3. Next Steps: If you notice blood in your stool, it is crucial to consult a healthcare provider. Here are the typical steps that may follow:
- Initial Evaluation: Your doctor will likely start with a thorough history and physical examination. They may ask about the characteristics of the blood, associated symptoms (such as abdominal pain, weight loss, or changes in bowel habits), and your medical history.

- Digital Rectal Exam (DRE): This is often performed to check for any abnormalities in the rectum and to assess for hemorrhoids or other issues.

- Stool Tests: Your doctor may recommend stool tests, such as a fecal occult blood test (FOBT) or fecal immunochemical test (FIT), to check for hidden blood in the stool.

- Colonoscopy: If there is a concern for colon cancer or if the initial tests indicate the need for further investigation, a colonoscopy is typically recommended. This procedure allows for direct visualization of the colon and rectum and enables the physician to take biopsies if necessary.

4. When to Seek Immediate Care: If you experience significant bleeding, severe abdominal pain, or other concerning symptoms, seek medical attention promptly.
In summary, while blood in the stool can be a sign of colon cancer, it can also result from various other conditions. The best course of action is to consult a healthcare provider who can guide you through the necessary evaluations and determine if a colonoscopy or other diagnostic tests are warranted. Early detection and intervention are key in managing any potential issues effectively.

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