Bloody stools: Should I worry about them?

Dear Alice,

What does it mean if there is blood in your stool? Is it serious or should I worry?

Dear Reader,

There are lots of different medical conditions that can cause blood to appear in a person's stool, ranging from minor concerns to a more serious or long-term medical condition. Only a health care provider can determine the cause of the blood in the stool. People who experience blood in their stool are urged to seek medical advice to rule out any serious problems.

Some of the causes of blood in stool may include:

  • Anal fissures, which are small cracks or tears around the anus that can be caused by large or forceful bowel movements or anal sex (including insertion of fingers, sex toys, etc.)
  • Hemorrhoids (also known as piles), which are enlarged veins in the lower part of the rectum or anus
  • Infection or disease in the gastrointestinal (GI) tract such as bacterial infections, stomach ulcers, or inflammatory bowel disease (IBD)
  • Tumors or cancer of the GI tract such as polyps or colon cancer

Before your appointment, you may consider observing your symptoms and taking note of them in preparation for a conversation with your health care provider. First, how much blood is there? A large quantity of blood (say enough to color the water in the toilet pinkish-red or show up as visible clots) can be a sign of a life-threatening bleed in the GI tract, which requires emergency medical treatment. Small amounts of blood may not necessarily mean a small problem, though — for example, one of the early signs of colon cancer is the presence of minute amounts of hidden (or occult) blood in stools — so it’s wise to follow up with a health care provider after any amount of blood in the stool. Second, what color is your stool? Bleeding in the GI tract can produce stools that are maroon-colored or black and tar-like. However, some foods and medicines can also cause black or tar-like stools (including blueberries, black licorice, and pink bismuth) or maroon ones (e.g., beets). Having this information to share with a health care provider can help give them information that could inform next steps.  

When you visit a health care provider, they'll likely do a physical exam and review your health history in order to begin to determine the cause. They may also do some blood tests. There are a variety of procedures they may use to assist with diagnosis, ranging from endoscopies (where a scope is inserted into the throat or rectum), X-rays, to a computerized tomography (CT) scan. These various methods can help to determine what may be causing the bleeding. In terms of treatment, endoscopies (through injections), medications, hemorrhoid removal, and laser therapies may all be options, depending on the cause of the bleeding. In some cases, surgery may be necessary. A health care provider would make recommendations based on their findings and what would be most appropriate for the condition and your health history.  

Best of luck figuring out the cause!

Take care,

Last updated Aug 28, 2020
Originally published Apr 18, 2002

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