Definition & Symptoms
Visible blood in stool is often a concerning symptom that prompts patients to seek evaluation. Blood in stool can appear bright red, maroon, or black. Some patients may see small amounts of blood while wiping and others may see blood mixed in with their stool or clots. Symptoms of more severe blood loss include fatigue, dizziness, and loss of consciousness.
Blood may be passing through the rectum from any part of the gastrointestinal tract. Blood coming from the upper part of the gastrointestinal tract may originate from peptic ulcers, gastritis, esophagitis, esophageal varices (in patients with chronic liver disease), malignancies, or other vessel abnormalities.
Bleeding from the lower part of the gastrointestinal tract includes hemorrhoids, fissures, bleeding diverticula, rectal ulcers, abnormalities of blood vessels, malignancy, or a flare in chronic inflammatory conditions such as bowel infections and inflammatory bowel diseases.
Risk factors for gastrointestinal bleeding include a personal history of peptic ulcer disease, gastritis, esophagitis, gastrointestinal cancer, liver cirrhosis, inflammatory bowel disease, and chronic use of NSAIDs, smoking or alcohol.
Any gastrointestinal bleeding should be taken seriously and one should seek medical attention promptly. Diagnostic work up may include blood work, CT scans, and upper endoscopy and colonoscopy. If the blood loss is large, IV hydration and blood transfusions may be indicated.
The goal of diagnostic testing is to find the source of the bleeding and to treat accordingly. If the cause is more benign, such as the case with hemorrhoids or fissures, these can be treated in the outpatient setting. Acute GI bleeding may require urgent work up and hospitalization for supportive care and treatment of the bleed.