Blood in the stool is not normal. It can come from hemorrhoids, fissures, ulcers, or polyps. See a doctor, and seek emergency care for heavy bleeding.
Not normal
Blood in stool always needs checking.
Causes
- Hemorrhoids.
- Anal fissures.
- Diverticular disease.
- Ulcers.
- Polyps or colorectal cancer.
- Inflammatory bowel disease.
Color
Bright red usually comes from the lower tract. Black, tarry stool suggests upper gastrointestinal bleeding.
See a doctor
Soon. Go to emergency care for heavy bleeding, dizziness or severe pain.
Type of bleeding
Blood in stool is never considered normal and should be evaluated. It can appear as bright red blood on toilet paper or in the bowl (hematochezia), maroon stool, or black tarry stool (melena) from bleeding higher in the digestive tract.
Common causes of bright red blood
- Hemorrhoids, swollen veins in the rectum or anus, which affect about 1 in 20 Americans, especially with straining or constipation.
- Anal fissures, small tears causing sharp pain with bowel movements.
- Diverticular disease.
- Infectious colitis.
- Inflammatory bowel disease.
- Colon polyps and colorectal cancer.
Black stool causes
Bleeding from stomach ulcers, gastritis, esophageal varices or tumors. Iron supplements, bismuth subsalicylate (Pepto Bismol) and black licorice can also darken stool without bleeding.
Red foods
Beets, tomato juice and red gelatin can resemble blood.
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When to act urgently
Heavy bleeding, dizziness, fainting, a fast heart rate, severe abdominal pain, black tarry stool, vomiting blood or signs of shock call for emergency care.
When to see a doctor
Any rectal bleeding that persists beyond a day or two, recurs, or occurs with weight loss, changes in bowel habits, anemia or family history of colon cancer. The US Preventive Services Task Force recommends colorectal cancer screening beginning at age 45.
Tests
Doctors may perform a rectal exam, stool tests, colonoscopy, blood tests (complete blood count).
Self care for hemorrhoids
Fiber, fluids, sitz baths and avoiding straining. Do not assume bleeding is from hemorrhoids without evaluation.
Where bleeding comes from
Bright red blood on toilet paper or in the bowl usually comes from the lower digestive tract or anus, with hemorrhoids and anal fissures being the most common causes. About half of adults develop hemorrhoids by age 50. Diverticular bleeding, colon polyps, colitis and colorectal cancer can also cause bleeding. Black, tarry, sticky stool (melena) suggests bleeding higher up, such as from a stomach ulcer, and needs urgent care. Red foods such as beets, tomato juice, red gelatin and some medicines like iron or bismuth can mimic blood, so consider recent foods.
When to seek care
Rectal bleeding is not normal and should be evaluated, even if hemorrhoids are suspected. Go to the emergency room for heavy bleeding, dizziness, fainting, fast pulse, severe abdominal pain or black stools. The US Preventive Services Task Force recommends colorectal cancer screening for adults aged 45 to 75, and cancer is rising in younger adults. A doctor may do a rectal exam, blood tests, colonoscopy or stool tests. To prevent constipation and straining, eat fiber, drink fluids and avoid sitting long on the toilet.
Based on data from the American Cancer Society and the USPSTF
