Pooping Blood—What Does it Mean and Should I See a Doctor?

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When you’re pooping blood, it’s normal (and smart) to wonder what’s going on there. Finding blood in your poop can be scary and raise a lot of questions, including the not-so-minor Q of “Why, exactly, am I pooping blood?”

If you search online for something like “Why am I pooping blood?” you’ll get a lot of the same advice: See a doctor. We’ve even said it too. Still, if we’re being real, most people aren’t likely to sprint to the doctor’s office when they see a bit of blood in their poop or on their toilet paper, especially if it just happens once or twice then goes away.

Still, as you know from a lifetime of pooping, rectal bleeding isn’t a typical thing. So how do you know if you can brush it off or if you need to call your doctor immediately? We asked some experts about why you might be pooping blood, so you don’t have to.

What Is It

Pooping blood sounds pretty straightforward, but it can actually mean a few different things depending on where the blood is coming from. The blood that you notice in your poop or when you wipe could be coming from your rectum, your lower colon, or other areas of your digestive system. For instance, the Mayo Clinic explains that “rectal bleeding” typically refers to bleeding coming from your lower colon or rectum. The small volume of red blood that you may notice coating your poop, staining your toilet paper, or dropping into the toilet bowl are all most commonly coming from the rectum. But blood in your poop can also come from other areas of your digestive system. For example: A gastric ulcer, which is an open sore that develops on the inside lining of your stomach, can cause bleeding in your G.I. tract that leads to bloody poop, according to the Mayo Clinic.

What Causes It

It’s hard to self-diagnose why you have blood in your poop, and this is why the “See your doctor” recommendation is so popular. In general, any bleeding in your gastrointestinal tract happens because blood vessels are exposed and bleeding into the lumen of the G.I. tract. This is always abnormal, and the actual underlying reason varies based on the disease process and the location. It’s your doctor’s job to help you narrow it down.

Though it’s hard to figure out on your own why you’re finding blood in your poop, it’s still good to have some idea of what you might be dealing with. Here are the most common reasons you might see blood before you flush.

1. You have hemorrhoids.

Around three out of four adults will deal with these piles of swollen anal or rectal veins at some point in their lives, according to the Mayo Clinic. You can get them when you strain too much when trying to poop, sit on the toilet for too long, have diarrhea or constipation, or have anal sex, according to the Mayo Clinic. Pregnancy, which causes constipation and increases pressure on your lower body (including your anus), is another main cause. And increased body weight can also be a risk factor.

Sometimes you won’t even realize you have hemorrhoids, but straining to poop—and the resulting irritation—can make a hemorrhoid bleed, according to the Mayo Clinic. Here are some of the other symptoms of hemorrhoids, per the Mayo Clinic:

  1. An itchy or irritated anus

  2. Pain in your anal region

  3. A swollen anus

Like with anal fissures, this blood will typically be bright red. Since hemorrhoids form on or close to your anus, blood doesn’t have time to clot up and darken before it exits the premises, Ashkan Farhadi, M.D., a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California, tells SELF.

2. You have an anal fissure.

Your anus is lined with thin, moist tissue known as mucosa, and when you get a small tear in that mucosa, it’s known as an anal fissure. You usually get an anal fissure when you expel an extraordinarily hard or large poop, according to the Mayo Clinic. As you can imagine, that can cause pain and bleeding. The anal fissure-induced blood you’ll see on your T.P. or in the toilet will likely be bright red.

Other causes of anal fissure include constipation, chronic diarrhea, anal sex, and even giving birth, according to the Mayo Clinic.

3. It could be diverticulosis.

“Diverticulosis is the presence of little pouches in the colon, which can sometimes cause bleeding,” Kyle Staller, M.D., a gastroenterologist at Massachusetts General Hospital, tells SELF. According to the Cleveland Clinic, complications of these common pouches include rectal bleeding, and these complications affect about 20% of people with diverticulosis. These pouches can induce bleeding when they erode into blood vessels. 

4. You could have a polyp on your colon.

According to the Mayo Clinic, a polyp is a small mass of cells that can form on the lining of your colon, a.k.a. your large intestine. Though anyone can develop polyps, they’re more common in those who are 50 or older, who are overweight or a smoker, or who have a personal or family history of colon polyps or colon cancer. It’s normal to have a colon polyp without symptoms, but some people with polyps experience rectal bleeding and red or black poop, according to the NIDDK.

5. You ate something with E. coli

“Certain infections can cause colon inflammation that leads to bleeding, and that includes an infection caused by E. coli,” says Dr. Staller. “Certain strains of E. coli—usually the ones that make the news—can lead to bloody diarrhea and later lead to kidney failure.”

6. You have a peptic ulcer.

A peptic ulcer is an open sore that develops either on the inside lining of your stomach (gastric ulcer) or the upper portion of your small intestine (duodenal ulcer), per the Mayo Clinic. These ulcers can happen due to bacterial infections and the use of painkillers like aspirin, ibuprofen, and naproxen sodium.

While the majority of people with peptic ulcers have no symptoms, the most common symptom you might experience is abdominal pain, the Mayo Clinic says. However, in less common and more severe cases, you can also end up with dark blood in your poop. “It can look like driveway tar—it’s shiny and sticky and has a peculiar odor to it,” Gail Bongiovanni, M.D., a gastroenterologist and adjunct professor in the division of digestive diseases at the University of Cincinnati College of Medicine, tells SELF. This dark stool is also known as melena and can have a consistency like peanut butter. If you notice it, it suggests that you need an evaluation of your upper intestinal tract to locate the source of the bleeding. 

Though these are two different forms of inflammatory bowel disease (IBD), both Crohn’s and ulcerative colitis (U.C.) can cause chronic inflammation in your digestive tract that leads to bleeding ulcers, hence blood in your poop.

In case you’re not familiar with it, Crohn’s disease is a chronic disease that causes inflammation and irritation in your digestive tract, usually in your small intestine and the beginning of your large intestine, per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Ulcerative colitis is a chronic disease that causes irritation or swelling and sores called ulcers on the inner lining of your large intestine, the NIDDK says.

8. Blood in your poop could be a sign of colorectal cancer.

Bright red rectal bleeding can sometimes be due to colorectal cancer, according to the American Cancer Society. Colorectal cancer is tough to pin down—it may not cause symptoms right away, the American Cancer Society says, and when it does, rectal bleeding can show up alone or with other issues. You might also experience things like diarrhea, constipation, a persistent urge to poop, a change in your stool shape or size (i.e., they become pencil-thin), abdominal pain, weakness and fatigue, and unintended weight loss. 

Risk factors for colorectal cancer include a personal or family history of colorectal polyps, a personal or family history of irritable bowel disease like Crohn’s disease or ulcerative colitis, being Black, and being above 50, according to the American Cancer Society. (However, colorectal cancer rates are significantly on the rise in people younger than this.) 

What to Do When It Happens

Not to sound like a broken record here, but the whole “Call your doctor” advice comes up a lot with this kind of stuff for a reason. Still, sometimes you can try out a few things on your own. Of course, the advice is a little different depending on what you might be dealing with.

If it’s hemorrhoids:

First things first: If you see blood in your poop and are over 45, Black, or have a family history of colorectal cancer, you should see a doctor to rule out other causes before deciding you must just have hemorrhoids. 

However, if you do actually have hemorrhoids, they usually clear up on their own. Still, they can stick around and cause persistent bleeding, Dr. Farhadi says. If hemorrhoids are indeed your issue, Dr. Farhadi recommends eating high-fiber foods to try to soften up your waste so pooping won’t require Herculean effort. (Be sure to also drink enough water, since the fiber soaks it up to help make poop softer and easier to pass.)

If it’s an anal fissure:

Christine Lee, M.D., a gastroenterologist at Cleveland Clinic, likens anal fissures to having a paper cut on your butt. Luckily, they usually get better on their own, though you can ask a doctor which anesthetic-containing cream they recommend to dull the pain in the meantime. It can also help to take a sitz bath and up your fiber intake (so that your future poops are a little more manageable), according to the Mayo Clinic.

If it’s a polyp in your colon:

Most of these polyps are harmless, but a small portion of them can develop into colon cancer over time. Doctors treat colon polyps by removing them endoscopically (using a flexible camera with a light, also called an endoscope), then making sure they’re not cancerous, says the NIDDK.

If it’s diverticulosis:

Diverticular bleeding sometimes stops on its own. If it doesn’t, your doctor may do a colonoscopy to figure out where the bleeding is happening so they can put an end to it.

If it’s E. coli:

The good news: Healthy adults usually recover from E. coli in about a week, the Mayo Clinic says. In general, resting and drinking plenty of fluids to help prevent dehydration is the main thing to do. The bad news: E. coli that causes bloody diarrhea often makes people sick enough to wind up in the hospital. At the hospital, you can receive supportive care, like IV fluids, blood transfusions, and kidney dialysis.

Even if your E. coli is tame enough that you can recover at home, don’t take anti-diarrheal medication,  the Mayo Clinic warns. It slows down your digestive system and prevents your body from getting rid of the toxins.

If you have a peptic ulcer:

Doctors may prescribe drugs to neutralize irritating stomach acid or medications to help protect the tissues that line your stomach and small intestine, the Mayo Clinic says. In the event that your peptic ulcer is bleeding, you will need a procedure known as an upper endoscopy so a gastroenterologist can treat the bleed and stop it from bleeding again. 

If your doctor suspects Crohn’s disease or ulcerative colitis:

IBD treatment courses vary from person to person, but they can involve taking anti-inflammatory drugs like corticosteroids to tame inflammation, immunosuppressants to stop your immune system from attacking your digestive tract, and medicine to combat symptoms like diarrhea and constipation, according to the Mayo Clinic. Your doctor may also recommend surgery if other treatments haven’t helped as much as they should.

If you’re concerned it might be colorectal cancer:

Seek medical attention as soon as possible, especially if you have any of the aforementioned risk factors.  

Treatment and Tests

If you have blood in your poop, your doctor is going to need to do a little investigating to help figure out what’s behind it. There are a lot of different things your doctor may do to try to give you a diagnosis, per the NIDDK:

  • A physical exam. This will include listening to sounds in your abdomen with a stethoscope and tapping on certain areas of your body.

  • Lab tests. You can expect a blood test to help determine how much you’re bleeding and whether you have anemia, a condition where you don’t have enough healthy red blood cells to carry enough oxygen to your body’s tissues.

  • Endoscopy. This diagnostic test involves a gastroenterologist placing an endoscope into your gastrointestinal tract. When performed through the mouth, this is known as an upper endoscopy. When performed through the anus, it’s a colonoscopy. If you’re experiencing red blood in your poop, your gastroenterologist will usually start with a colonoscopy. If you’re experiencing poop with dark or black blood, your gastroenterologist will usually start with an upper endoscopy. Of course, there are exceptions to these rules.

  • Imaging tests. Those can include an abdominal C.T. scan, and an upper or lower G.I. series, where you swallow a chalky liquid called barium and then undergo X-rays to help your doctor see what’s happening in your G.I. tract.

  • Gastric lavage. This is a procedure where your doctor passes a tube through your nose or mouth into your stomach to try to find the cause of your bleeding. It’s not done often these days, but in rare cases, doctors do still do it when trying to distinguish between bleeding in the upper and lower G.I. tract.

  • Surgery. If none of the other tests help find a diagnosis, your doctor may recommend that you undergo surgery to try to figure out what’s happening. That can include a laparotomy, where a surgeon will make a cut in your abdomen and explore the area, or a laparoscopy, where a surgeon uses a laparoscope to make small cuts in your abdomen and then inserts special tools and a camera to try to find and treat the source of the bleeding.

Prevention

The best way to prevent having more bloody poop in the future really depends on what’s behind your symptom. If you have bloody poop due to something like an anal fissure or hemorrhoids, doing your best to eat high-fiber foods and drink plenty of water can help keep your poop small, manageable, and less likely to injure you on the way out. Also, being careful not to use painkillers over longer periods of time may help prevent peptic ulcers in your future. Being wary of unpasteurized milk and undercooked food like ground beef can lower your risk of a foodborne illness like E. coli that can lead to bloody poop.

Unfortunately, you can’t prevent Crohn’s disease, ulcerative colitis, colon polyps, and diverticulosis—those conditions are largely determined by things outside of your control, like genetics or aging. But, with all of these conditions, eating a well-rounded diet and exercising regularly may help make symptoms easier to manage.

When to See a Doctor

A little bit of bright red blood in your poop isn’t typically a huge cause for concern. If you’ve been in great health, saw a small amount of bright red blood just once, and the bleeding went away on its own, you probably don’t need immediate medical attention, Dr. Lee says. That bleeding is most likely due to a hemorrhoid or anal fissure. Your butt has a hard job to do, so bleeding can just come with the territory sometimes.

But if the blood in your poop is dark, you’re seeing a lot of it, or you’re experiencing other strange symptoms, see a doctor. Same goes for if your bleeding persists for days or goes away and comes back seemingly at random. Even if it doesn’t, it’s still a good thing to mention the next time you do visit your doctor. And, again, you should absolutely seek medical attention immediately if you notice blood in your stool and have any concern you may be at risk for colorectal cancer. 

Your other symptoms matter too. If you have bleeding and you’re also struggling with shortness of breath, abdominal pain, chest pains, dizziness, fatigue, and a fever, it could be a sign of bleeding in your G.I. tract, Dr. Lee says. This is another time that anal bleeding should mean an immediate trip to the doctor’s office.

If you’ve already been diagnosed with a health condition that can cause blood in your toilet bowl, like Crohn’s disease or ulcerative colitis, and you’re managing it with the help of your doctor, you don’t necessarily need to call your doctor every time you spot a little blood, Dr. Farhadi says. However, it’s crucial to put it into context. If you used to have a flare-up every two months and suddenly you’re seeing a significant amount of blood in your poop and more often than usual, you should call your doctor, he says—it could be a sign that your condition isn’t as well controlled as you thought.

Finally, beware of black poop.

If your poop is black, that’s a big red flag that could signal internal bleeding, Dr. Bongiovanni says. That said, eating things like black licorice, blueberries, beets, or taking iron supplements or certain medicines with Pepto-Bismol, can result in block poop, per the U.S. National Library of Medicine. So, rule of thumb: If your poop is black and you didn’t recently have any of these foods or drugs, get to a doctor ASAP, just in case.

Sources:

  • U.S. National Library of Medicine, Anal Disorders

  • Mayo Clinic, Rectal Bleeding

  • Mayo Clinic, Peptic Ulcer

  • Mayo Clinic, Anal Fissure

  • Mayo Clinic, Hemorrhoids

  • Mayo Clinic, Inflammatory Bowel Disease

  • National Institute of Diabetes and Digestive and Kidney Diseases, Symptoms & Causes of GI Bleeding

  • National Institute of Diabetes and Digestive and Kidney Diseases, Definition & Facts for Crohn’s Disease

  • National Institute of Diabetes and Digestive and Kidney Diseases, Ulcerative Colitis

  • National Institute of Diabetes and Digestive and Kidney Diseases, Symptoms & Causes of Colon Polyps

  • Cleveland Clinic, Diverticulosis and Diverticulitis of the Colon

  • National Institute of Diabetes and Digestive and Kidney Diseases, Definition & Facts for Diverticular Disease

  • Mayo Clinic, E.coli

  • American Cancer Society, Colorectal Cancer Signs & Symptoms

  • National Institute of Diabetes and Digestive and Kidney Diseases, Diagnosis of GI Bleeding

  • U.S. National Library of Medicine, Black or Tarry Stools

  • Mayo Clinic, Anemia Symptoms & Causes

  • National Cancer Institute, Lumen

Related Links:

  • Here’s Why Stress Messes With Your Poop

  • Gastroenterologists Share 9 Things to Do When You Have Painful Gas

  • 7 Things That Can Cause Bizarre Green Poop

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