Blood in stool, medically known as hematochezia or melena, indicates bleeding somewhere within the digestive tract. This can manifest as bright red blood on toilet paper or in the toilet, or as dark, tarry stools. While discovering blood can be unsettling, it is a symptom that requires professional medical evaluation to determine its origin and significance. Prompt assessment helps identify the cause, which can range from minor issues to more serious conditions.
Your First Medical Consultation
When you first notice blood in your stool, your primary care physician (PCP) or general practitioner is the appropriate initial point of contact. Your PCP can assess your health history, including any existing medical conditions or medications you are taking. This helps them understand the context of your symptoms.
During this initial visit, your doctor will likely ask detailed questions about the blood’s appearance, including its color (bright red, maroon, or black), amount, and frequency. They will also inquire about other accompanying symptoms, such as abdominal pain, changes in bowel habits, or unexplained weight loss. A physical examination, which may include a digital rectal exam, is performed to check for common causes like hemorrhoids or anal fissures.
Based on this initial assessment, your PCP can determine the potential source and decide whether further investigation or a referral to a specialist is necessary. They serve as a coordinator for your care, guiding diagnostic steps.
When a Specialist is Necessary
Following your primary care physician’s initial evaluation, a referral to a specialist may be necessary to pinpoint the cause of bleeding. The type of specialist depends on the suspected location and nature of the bleeding within the gastrointestinal (GI) tract. Gastroenterologists are internal medicine specialists who focus on the entire digestive system, from the esophagus to the rectum. They are involved when the bleeding source could be anywhere along this pathway, addressing conditions like ulcers, inflammatory bowel disease, or diverticulosis.
For issues involving the rectum and anus, a proctologist, also known as a colorectal surgeon, may be appropriate. These surgeons have training in conditions affecting the colon, rectum, and anus. They commonly treat conditions such as hemorrhoids, anal fissures, polyps or cancers in the lower GI tract. Your PCP will guide this referral decision, directing you to the specialist best equipped to investigate your symptoms.
These specialists possess expertise and tools for targeted examinations and procedures. Their focused knowledge allows for precise diagnosis and treatment. Understanding which specialist is involved helps clarify the path forward in addressing blood in the stool.
Common Diagnostic Approaches
To identify the source of bleeding, specialists employ diagnostic procedures. Stool analysis is a non-invasive test that can detect hidden (occult) blood or identify infections. Blood tests, such as a complete blood count (CBC), are also performed to assess for anemia and overall health markers.
Endoscopic procedures are used to visualize the inside of the digestive tract. A colonoscopy involves inserting a flexible tube with a camera into the rectum to examine the large intestine for polyps, inflammation, or bleeding sites. For bleeding higher in the GI tract, an upper endoscopy is performed, where a similar scope is passed through the mouth to view the esophagus, stomach, and upper small intestine. A flexible sigmoidoscopy is a shorter procedure examining the lower colon and rectum.
In some instances, imaging tests like CT scans or MRIs may be used to provide detailed pictures of abdominal organs and identify structural abnormalities or sources not visible with endoscopy. These tests collectively help the specialist pinpoint the cause of blood in the stool, guiding treatment decisions.
Signs Requiring Immediate Attention
While blood in stool always warrants medical evaluation, certain accompanying symptoms indicate a medical emergency. Large amounts of bright red blood in the stool, especially if it appears suddenly or continuously, is a sign. This can suggest active bleeding.
Severe abdominal pain, especially if sudden and intense, alongside blood in the stool, can signal a serious underlying issue. Other indicators include signs of shock, such as dizziness, lightheadedness, or fainting, which can occur due to blood loss. Rapid heart rate, confusion, or extreme weakness are also symptoms that require emergency care. If you experience any of these severe symptoms, it is imperative to seek immediate medical attention (call emergency services or go to the nearest emergency room). These signs suggest a potentially life-threatening situation.