Blood in Stool: When It’s Harmless, When to Worry and What the Color Means
Plus learn about less-invasive test options than a colonoscopy
When it comes to ranking the scariest phrases in the English language, “blood in the stool” is right up there. But is it always a harbinger of a serious health condition, or can it be a sign of something relatively benign? We asked a top gastroenterologist when you actually need to worry about blood in your stool, plus what the color of the blood may indicate and when you should see a medical professional.
If you have blood in your stool, err on the side of caution
Before going any further, it must be said that blood in the stool shouldn’t be taken lightly, especially if this is the first time you’re experiencing it. “In gastroenterology—and especially when it comes to blood—anything new should be addressed by a medical professional,” says Anish A. Sheth, MD, chief of gastroenterology at Penn Medicine, Princeton Medical Center and author of What’s Your Poo Telling You? “Your physician may say, this is nothing or let’s keep an eye on it.”
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Dr. Sheth adds that this is a particularly prudent step in light of colorectal cancer rates rising in younger people: “Sometimes, blood is the first sign of cancer, and there aren’t other symptoms. It doesn’t mean that every time you see blood in the stool there’s a very high chance of cancer, but it warrants some monitoring so that we know if we need to do further testing.”
When you likely don’t need to worry about blood in stool
If you’ve ever looked down at your toilet paper after you’ve wiped and spotted red, you have plenty of company. This is the most common scenario people experience blood during a bowel movement, notes Dr. Sheth.
“Most people’s initial assumption, which is often correct, is that this is hemorrhoidal bleeding,” he says. Indeed, if you see blood only on the toilet paper—and none in the stool or toilet—you’ve likely irritated a few hemorrhoids near the rectum or anus.
The good news: Intermittent hemorrhoidal bleeding is easily treated with over-the-counter remedies like hydrocortisone, an anti-inflammatory cream that decreases the irritation.
As for addressing the root cause of hemorrhoids, Dr. Sheth says there are two main villains: hard stool and straining too much when you push. “Increasing your fiber intake, drinking more water and fixing the stool hardness issue with a stool softener can be very helpful.”
Alcohol and spicy foods can also be to blame, so it’s not uncommon to see a bit of spotting after too much wine or hot sauce the night before. If this pattern isn’t associated with other symptoms, you probably don’t need to do anything else except monitor it, he assures.
When to worry about blood in your stool
While seeing red on your toilet paper may point to relatively harmless hemorrhoids, if the blood is mixed with the stool or appears in the toilet, the cause may be more serious, reveals Dr. Sheth.
“In general, when intermixed with the stool, it means the blood is potentially coming from higher up in the colon, not just from the exit point,” he explains. Of course, if you see large amounts of blood, go to the emergency room immediately. The quantity, frequency of bleeding and appearance of the blood are just a few factors a medical professional will assess.
“Depending on the person’s age and other associated symptoms [such as abdominal pain], the physician will decide who needs to get an evaluation,” he says, adding that a few common causes of blood in the stool include:
- Polyps in the colon
- Colitis (inflammation of the colon)
- Diverticulosis (pockets forming in the digestive tract; more common in older adults)
- Colon cancer
Other potential causes of blood in stool include Crohn’s disease in the large intestine and ulcerative colitis, a type of inflammatory bowel disease (IBD) that could cause rectal bleeding.
What the color of blood in the stool may mean
The general rule of thumb is the darker the blood, the higher its point of origin in the GI tract. Here, Dr. Sheth describes what different shades of blood may point to:
Bright red blood
As he has noted, this hue is typically associated with hemorrhoids, but it can also point to other conditions like polyps or anal fissures.
Maroon or black blood
Black blood in the stool is a sign of bleeding from the upper part of the GI tract, Dr. Sheth observes. “This may be from the stomach, and one potential cause could be an ulcer,” he says, explaining that as the blood makes its way through the body and it gets digested by stomach acids, enzymes and bile, it turns a darker color.
Iron supplements and Pepto Bismol can also cause black blood and a “very tarry consistency” in the stool, he adds.
The best diagnostic tools
You’re already familiar with a colonoscopy—which experts highly recommend scheduling starting at the age of 45—but that’s not the only “scope” in the gastroenterologist’s toolkit. “There are some in-office exams a doctor can perform that require neither anesthesia nor bowel preparation,” Dr. Sheth reveals. Consult your medical professional to learn if one of these procedures might be right for you:
Anoscopy
Like a speculum but for the anal area, this procedure can take just a few minutes in a doctor’s office and is a great way to determine if hemorrhoids are causing the bleeding, he says.
Sigmoidoscopy
A partial colonoscopy, this procedure is used to look at just the bottom part of the colon, he says. “Sometimes we’ll do this when we want to get just a little bit more of a look inside. Again, the advantage is that it doesn’t require anesthesia or a full bowel preparation.”
The bottom line: Look before you flush
That’s the unofficial bathroom mantra Dr. Sheth encourages us all to live by. “Nobody really wants to do it, but you can pick up on things—sometimes serious conditions—just by periodically checking your stool and making sure there’s no blood.”
He reiterates that this is especially important because some of the most concerning diseases, like colon cancer, that can lead to blood in the stool don’t always cause other symptoms like pain or anal discomfort. “So, it’s great to get into the habit of looking at the toilet bowl and monitoring your stools.”
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