Stool Color Changes: When to Worry About Blood

The color of stool?

Hello Doctor, I would like to ask some questions related to colorectal surgery.
I have been suffering from chronic constipation, and for a while, I noticed that there was a faint red color on the edges of my stool in the toilet water, but there was no blood on the toilet paper.
I would like to know if this is considered blood in the stool? Do I need to go to the hospital for a fecal occult blood test? I have done this test once before, and the doctor said everything was fine, but my stool continues to show a faint red color as mentioned above.
Additionally, I have been constipated for nearly ten years, and I am very concerned that this could be a sign of colorectal cancer.
Since my constipation is mainly due to weak intestinal motility, are there any effective methods to improve this? Thank you.

Ms. Chen, 20~29 year old female. Ask Date: 2015/11/10

Dr. Ke Fangxu reply Surgery

Yes, this can be considered as hematochezia.
If the bleeding is visible to the naked eye, there is no need for further occult blood testing to confirm it.
Young women often experience persistent constipation, and it is advisable to increase dietary fiber intake and drink plenty of water, which is a common recommendation.
If these measures are still ineffective, pharmacological treatment should be considered to prevent potential harm to health.

Reply Date: 2015/11/10

More Info

When it comes to changes in stool color, particularly the presence of red hues, it is essential to approach the situation with caution and awareness of the potential underlying causes. The presence of a faint red color in your stool can indeed be concerning, especially if you have a history of constipation and are worried about the possibility of serious conditions such as colorectal cancer.

Firstly, it is important to differentiate between the types of blood that may appear in stool. Bright red blood typically indicates bleeding from the lower gastrointestinal tract, such as the rectum or anus, while darker red or maroon blood may suggest bleeding from higher up in the gastrointestinal tract. The fact that you are observing a faint red color in the toilet water but not on the toilet paper could suggest that the blood is mixed with the stool or that it is coming from the rectal area.

Given your long-standing issue with constipation, it is possible that the faint red color could be due to hemorrhoids or anal fissures, which can occur when straining during bowel movements. These conditions can lead to minor bleeding, which may not always be visible on toilet paper but can affect the water in the toilet bowl. However, it is crucial to rule out more serious conditions, including polyps or colorectal cancer, especially since you have expressed concern about these possibilities.

You mentioned that you have previously undergone a fecal occult blood test, which returned normal results. While this is reassuring, it does not completely eliminate the need for further evaluation, especially if the symptoms persist. If the faint red color continues or worsens, or if you experience any additional symptoms such as significant changes in bowel habits, weight loss, or abdominal pain, it would be prudent to consult with a healthcare professional for further investigation. This may include a colonoscopy, which is a more definitive test that allows for direct visualization of the colon and rectum, and can help identify any abnormalities.

In terms of managing your chronic constipation, there are several strategies you can consider to improve bowel function and reduce the risk of complications. Here are some recommendations:
1. Dietary Changes: Increasing your fiber intake can help promote regular bowel movements. Aim for a diet rich in fruits, vegetables, whole grains, and legumes. Fiber adds bulk to the stool and can help it pass more easily through the intestines.

2. Hydration: Ensure you are drinking enough water throughout the day. Adequate hydration is essential for softening stool and preventing constipation.

3. Regular Exercise: Engaging in regular physical activity can stimulate bowel motility. Aim for at least 30 minutes of moderate exercise most days of the week.

4. Establish a Routine: Try to set aside time each day for bowel movements, especially after meals when the gastrocolic reflex is strongest. This can help train your body to have regular bowel movements.

5. Over-the-Counter Laxatives: If dietary changes and lifestyle modifications are insufficient, you may consider using over-the-counter laxatives. However, these should be used sparingly and under the guidance of a healthcare provider to avoid dependency.

6. Consult a Specialist: If your constipation persists despite these measures, it may be beneficial to consult a gastroenterologist. They can provide a more comprehensive evaluation and recommend specific treatments tailored to your condition.

In summary, while the faint red color in your stool may not necessarily indicate a serious problem, it is essential to monitor the situation closely and seek medical advice if symptoms persist or worsen. Taking proactive steps to manage your constipation can also help improve your overall gastrointestinal health and reduce the risk of complications.

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