What does the color of blood mean?
Fresh scarlet blood that remains on paper or drops on top of the stool almost always comes from the anus and lower rectum. Dark red blood mixed with stool indicates a higher level - the sigmoid or colon. Black, liquid stool with a sheen means that the blood has had time to pass through the stomach and intestines and has been changed by acid: the source is located in the esophagus, stomach or duodenum. Sometimes blood is not visible at all and can only be detected by a stool occult blood test.
- Scarlet blood on top of stool - anus, rectum
- Dark blood mixed with stool - large intestine
- Black tarry stools - stomach and duodenum
- Blood with mucus and pus - inflammation of the intestines
- Occult blood - detected only by analysis
Common reasons
The most common cause of scarlet blood is hemorrhoids: blood appears at the end of a bowel movement, is not mixed with feces, and there may be no pain. In second place is anal fissure, in which blood is accompanied by a sharp burning pain during and after stool. Blood mixed with feces is caused by polyps, diverticula, ulcerative colitis and Crohn's disease, infectious colitis, and colon tumors. Black stools are most often associated with gastric or duodenal ulcers and bleeding from dilated veins of the esophagus in cirrhosis.
- Hemorrhoids
- Anal fissure
- Colon polyps
- Diverticular disease
- Ulcerative colitis and Crohn's disease
- Infectious colitis
- Colorectal cancer
- Stomach and duodenal ulcers
When it's not blood
Red or black stool does not always mean bleeding. Beets, pomegranate, tomato juice, dyes in drinks and sweets color stool a reddish tint, and iron supplements, activated carbon, blueberries and chokeberry make it dark. This type of stool is usually well formed and is not accompanied by weakness. If doubts remain, the question is resolved by a stool test for occult blood. But if you have black, loose stools with signs of weakness, diet cannot be considered the cause—you need to urgently consult a doctor.
- Beetroot, pomegranate, tomatoes and red dyes
- Iron and bismuth preparations
- Activated carbon
- Blueberries and chokeberries
- Blood from the nose or gums, swallowed during sleep
What examinations are needed
They begin with an examination by a proctologist: he conducts a digital examination of the rectum and anoscopy, which immediately reveals hemorrhoids and a fissure. Even if hemorrhoids are found, if there are alarming signs or if you are over 45 years old, be sure to examine the entire colon. Sigmoidoscopy shows the rectum and sigmoid colon, colonoscopy shows the entire colon with the ability to take a biopsy and immediately remove the polyp. A complete blood count and ferritin show whether there is hidden blood loss and anemia. For black stools, gastroscopy is performed.
- Examination by a proctologist, digital examination, anoscopy
- Sigmoidoscopy
- Colonoscopy with biopsy
- Fecal occult blood test
- Complete blood count, ferritin, iron
- Gastroscopy for black stools
- Calprotectin for suspected inflammatory bowel disease
Treatment and prevention
Treatment depends entirely on the cause. Hemorrhoids in the early stages are treated with a diet, mild laxatives and local remedies; with progression, node ligation, laser techniques or hemorrhoidectomy are used. Anal fissure is treated with healing agents that relax the sphincter and normalization of stool; in the chronic form, with surgery. Polyps are removed endoscopically, inflammatory bowel diseases are treated by a gastroenterologist. The main prevention is regular soft stools: a sufficient amount of fiber and water, movement, avoidance of prolonged straining and sitting on the toilet with the phone.
- Normalization of stool: fiber, water, regimen
- Local treatment of hemorrhoids and fissures as prescribed by a doctor
- Minimally invasive techniques and surgery for progression
- Endoscopic removal of polyps
- Colon cancer screening from 45–50 years of age
- Do not delay examination even if you have “habitual” hemorrhoids