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Blood in stool. When to worry?

Blood in stool is a very common complaint. It occurs in upto 15% of the population. A lot of people never report it and only a few report this to the physician. Small amounts of blood on the surface of the stool is also considered minimal BRBPR, but red blood intermixed with stool is not. Commonly it is from benign causes particularly in younger population. It could however be the first presentin symptom of colorectal cancer.
Hemorrhoids are present in 30-90% of cases. People older than 40 and those with family history of colon cancer should be evaluated with colonoscopy for colon cancer.

Common causes of blood in stool include:

  • Hemorrhoids
  • Anal Fissure
  • Colon Polyps
  • Proctitis
  • Colitis
  • Rectal ulcers
  • Colon or Rectal Cancer
  • Important Points:

  • Hemorrhoids are very common and presence of hemorrhoids does not rule out co-existence of another lesion in the rest of the colon.
  • Older age, shorter duration of bleeding, and blood mixed with stool were associated with a serious cause of rectal bleeding.
  • Anal pain suggests presence of anal fissure, anal or rectal carcinoma or proctitis etc.
  • Bright red blood per rectum ( aka BRBPR) suggest lesion in anal canal or left colon typically.
  • Melena is black stool where blood is mixed with stool and usually means bleeding from stomach, small intestine or slow bleeding from right side of the colon.
  • Red flags – Patients with minimal BRBPR in the following categories should undergo additional testing with colonoscopy regardless of age:

    History of black stools
    Presence of weight loss, anemia, loss of appetite
    Change in frequency, caliber or consistency of stools
    Positive occult blood in stool
    Family history of colon caner
    Age over 40
    Persistent bleeding despite treatment of hemorrhoids or anorectal lesions

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    Posted in Colon Cancer Risk, Colonoscopy.


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