Blood in Stool: Causes and Differentiation Tips - Gastroenterology and Hepatology

Blood in the stool?

Hello doctor, yesterday when I went to the bathroom, I noticed blood in my stool.
It wasn't a lot; there were some on the surface and some mixed in with the stool.
I used a stick to poke around and see it.
I have seen a doctor before and have internal hemorrhoids.
Could this be caused by the internal hemorrhoids? I read online that blood from internal hemorrhoids is usually on the surface of the stool, but can blood from internal hemorrhoids also mix in with the stool?
I have another small question: how can I distinguish between blood and food causing red stools? I read online that a way to differentiate is to see if it disperses in water; if it does, it's blood, and if it doesn't, it's food.
Does that mean if I use chopsticks to pick up the red part from the water and it doesn't spread, then it's caused by food? (I ate watermelon a few days ago, which is why I'm asking this question, but the blood I saw was bright red, so I think the likelihood of it being from watermelon is low.)

Xiao Jia, 20~29 year old female. Ask Date: 2015/08/12

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, based on your description, the likelihood of blood in the stool is quite high, with hemorrhoidal bleeding being the most probable cause.
If the bleeding persists, a consultation with a colorectal surgeon is necessary.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/08/12

More Info

When it comes to the presence of blood in stool, it is crucial to understand the potential causes and how to differentiate between them. Blood in the stool can be alarming, and while it can be caused by various conditions, some are more common than others.
In your case, you mentioned having a history of internal hemorrhoids (or internal piles). Hemorrhoids are swollen veins in the lower rectum and anus that can cause bleeding, especially during bowel movements. The blood from hemorrhoids is typically bright red and may appear on the surface of the stool or on toilet paper. It is possible for the blood to mix with the stool, especially if the hemorrhoids are more severe or if there is significant straining during bowel movements. Therefore, it is plausible that your internal hemorrhoids could be the cause of the blood you observed.

However, it is essential to consider other potential causes of blood in the stool as well. These can include:
1. Anal fissures: Small tears in the lining of the anus, often caused by passing hard stools, can lead to bright red blood on the stool or toilet paper.

2. Diverticular disease: This condition involves small pouches that can form in the walls of the colon and may bleed.

3. Colorectal polyps or cancer: These can also cause bleeding, and the blood may appear mixed with the stool or as streaks on the surface.

4. Gastrointestinal infections: Certain infections can lead to inflammation and bleeding in the gastrointestinal tract.

To differentiate whether the red color in your stool is due to blood or food, your method of testing is generally correct. When you place the stool in water, blood will typically disperse and create a reddish hue in the water, while food particles (like those from watermelon) will not disperse in the same way. If you were to take a piece of the stool and place it in water, and it does not spread out, it could indicate that the color is due to food rather than blood. However, it is important to note that this is not a foolproof method, and the presence of blood should always be taken seriously.

Given your symptoms and history, it is advisable to consult with a healthcare professional for a thorough evaluation. They may recommend a physical examination, possibly a digital rectal exam, and further diagnostic tests such as a colonoscopy, especially if the bleeding persists or if you experience other symptoms like abdominal pain, changes in bowel habits, or weight loss.

In summary, while internal hemorrhoids could be the cause of the blood in your stool, it is essential to rule out other potential causes. Monitoring your symptoms and seeking medical advice will provide clarity and ensure appropriate management. Remember, any new or unusual symptoms warrant a discussion with your healthcare provider to ensure your health and well-being.

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