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Rectal bleeding

Rectal bleeding; Blood in the stool; Hematochezia; Lower gastrointestinal bleeding

Rectal bleeding is when blood passes from the rectum or anus. Bleeding may be noted on the stool or be seen as blood on toilet paper or in the toilet. The blood may be bright red. The term "hematochezia" is used to describe this finding.

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Considerations

The color of the blood in the stools may indicate the source of bleeding.

Black or tarry stools may be due to bleeding in the upper part of the GI (gastrointestinal) tract, such as the esophagus, stomach, or the first part of the small intestine. In this case, blood is most often darker because it gets digested on its way through the GI tract. Much less commonly, this type bleeding can be brisk enough to present with bright rectal bleeding.

With rectal bleeding, the blood is red or fresh. This usually means that the source of bleeding is the lower GI tract (colon and rectum).

Eating beets or foods with red food coloring can sometimes make stools appear reddish. In these cases, your doctor can test the stool with a chemical to rule out the presence of blood.

Causes

Rectal bleeding causes include:

When to Contact a Medical Professional

Contact your health care provider if there is:

You should see your provider and have an exam, even if you think that hemorrhoids are causing the blood in your stool.

In children, a small amount of blood in the stool is most often not serious. The most common cause is constipation. You should still tell your child's provider if you notice this problem.

What to Expect at Your Office Visit

Your provider will take a medical history and perform a physical exam. The exam will focus on your abdomen and rectum.

You may be asked the following questions:

You may need to have one or more imaging tests to look for the cause:

You may have one or more lab tests before, including:

References

Cheatham JG, Horwhat JD. Lower gastrointestinal tract bleeding. In: McNally PR, ed. GI/Liver Secrets Plus. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 51.

Lamps LW. Anus. In: Goldblum JR, Lamps LW, McKenney JK, Myers JL eds. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia, PA: Elsevier; 2018:chap:18.

MacGilchrist A, Iredale J, Parks R. The gastrointestinal system. In: Douglas G, Nicol F, Robertson C, eds. Macleod's Clinical Examination. 13th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 8.

Melton-Meaux GB, Kwaan MR. Hemorrhoids, anal fissure, and anorectal abscess and fistula. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier Saunders; 2018:210-213.

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Review Date: 6/18/2018  

Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Smyrna, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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