Hematochezia or Blood in Stool: Causes, Symptoms, Treatment, Diagnosis, Prevention

Many people complain of Hematochezia or blood in the stool. Mostly this sort of problem occurs due to bleeding in the upper or lower gastrointestinal region. The color of the stool, if it bears blood with it may look unusual. It is very important to visit a doctor to evaluate the characteristics of the bleeding. A blackish stool may signify an ulcer or any other problem associated with the upper part of the digestive track like colon while a red blood or maroon colored stool normally indicates problems in the lower part of the digestive tract. Pathological testing and thorough investigation is required to fix the problem as continuous fresh blood in stool due to Hematochezia might be dangerous.

Hematochezia normally refers to free blood in the stool. The cause of Hematochezia lies in the lower gastrointestinal (GI) tract, but in some instances too much bleeding from the upper portions of the gastrointestinal regions has also found to cause hematochezia. However, upper gastrointestinal bleeding mostly results into black tarry stool, which is referred to as Melena. This occurs as the released blood is digested partially or completely in the intestine. Blood released into the intestine from bleeding in the lower gastrointestinal tract is not digested and commonly results in frank blood or hematochezia. In some cases, slow rate of bleeding from the upper part of the lower GI tract may present as melena instead of hematochezia.

Commonly occurring symptoms of Hematochezia or Blood in Stool are as follows:

• Sudden cramps in lower abdomen
• Swollen lower abdomen which is visible from outside
• Frequent Constipation or diarrhea
• Fatigue
• Dizziness
• Fever with weakness

For some patients, Hematochezia can become life threatening if the quantity of bleeding increases suddenly. Hence, a person who experiences the below mentioned symptoms should seek immediate medical help:

• Problem in breathing
• Continuous abdominal pain
• Vomiting of blood
• Dizziness
• Fluctuation in the level of consciousness.

Hematochezia by and large appears from a colonic site. In many older patients, substantial lower intestinal hemorrhage is caused by bleeding due to an arteriovenous malformation or diverticulum. Arterial Diverticular bleeding tends to be rapid. On the other hand, in arteriovenous malformation, repeated, often smaller hemorrhages are more detectable. The other common causes of Hematochezia are as follows:

• Peptic Ulcer
• Ulcerative Colitis
• Necrotizing Enterocolitis
• Gastric Cancer
• Different types of Inflammatory Bowel Diseases
• Salmonellosis
• Food poisoning due to E-coli
• Anal fissures or anal hemorrhoids, particularly if they rupture or are irritated.
• Solitary rectal ulcer syndrome
• GI bleeding in sports persons.

Apart from these, there may be many other causes of Hematochezia, which can be detected through proper diagnostic methods.

CT Scanning is advised for Hematochezia as an initial diagnosing process. Colonoscopy is the most commonly used diagnosis process for identifying the cause of Hematochezia or blood in stool. Apart from colonoscopy, endoscopic procedures, such as Wireless Capsule Endoscopy (WCE), Esophagogastroduodenoscopy (EGD), Double-balloon Enteroscopy, and Push Enteroscopy are used depending on the clinical circumstances.

The two other nonsurgical modalities used to diagnose Hematochezia or blood in stool are radionuclide scans, and angiography. The order of using various diagnostic modalities depends on the factors as rate of bleeding, hemodynamic status of the patient, and failure to pinpoint bleeding with the initial tests.

Patients who have experienced multiple episodes of Lower GI Bleeding (LGIB) without any diagnosis need to undergo upper and lower endoscopy, upper GI series with small bowel, Meckel scanning, elective mesenteric angiography and enteroclysis. Elective evaluation test of the whole GI tract may identify unusual lesions and undiagnosed arteriovenous malformations.

Some blood tests are also undertaken in this condition like a complete blood cell test; serum electrolytes levels test and a coagulation profile test, including bleeding time test, prothrombin time (PT) test, activated partial thromboplastin time (aPTT) test, and manual platelet count test.

Rectal bleeding of any form including Hematochezia is managed by a gastroenterologist, a proctologist or a rectal surgeon.

Treatment for Hematochezia or Blood in Stool depends on the symptoms of the disease and patient’s overall health condition. Diagnosis of the problem for which Hematochezia is surfacing is needed to be fixed first and treatment is to be undertaken accordingly.

Treatment of Hematochezia or blood in stool involves management of rectal bleeding that includes the following:

• Treatment for Anemia and Low Blood Volume Caused due to Hematochezia or Blood in Stool: Moderate to profuse bleeding may cause anemia accompanied by low blood pressure, dizziness and even shock. Patients with these problems are hospitalized and treated with blood transfusion and intravenous fluids. To undertake diagnostic tests like colonoscopy and angiogram, treatment for anemia and low blood volume are the first and must step.
• Detecting the Cause and the Location of the Bleeding: Diagnosis of the main problem and localizing the source of the problem are possible through different diagnostic methods like colonoscopy, radionuclide scans, and angiography. Certain blood tests are also undertaken to fix the problem.
• Guard Against Frank Bleeding and Preventing Re-Bleeding: Colonoscopy is also used to prevent bleeding by removing bleeding polyps by cauterizing (a process whereby the affected area is sealed by electrical current) bleeding postpolypectomy ulcers or angiodysplasias.

In many occasions colonoscopy is not sufficient to identify the spot of bleeding or may not be able to stop recurrent bleeding. In such situations, visceral angiograms is very helpful, whereby the bleeding site is spotted with the help of an angiogram, medications are pushed through the angiographic catheter to seal the bleeding blood vessels and stop the bleeding. Microscopic coils are sometimes infused through the catheter to plug the bleeding blood vessel.

If both these processes fail to stop bleeding, then the doctors may ask for surgery. Mild bleeding due to anal fissures and hemorrhoids are treated with local measures such as hemorrhoidal creams, sitz baths, and stool softeners. There are several other nonsurgical and surgical treatments available to treat mild to moderate bleeding.

• Detecting Other Non-Bleeding Lesions That Can Bleed In Future: Several blood and stool tests are performed to detect the presence of other non-bleeding lesions. In most of the situations the above mentioned non-surgical and surgical processes can detect and cure these problems.

Most physical problems that cause Hematochezia are preventable, but this may not be the case always:

• One of the major causes of Hematochezia or blood in stool is Hemorrhoids. This can be avoided with proper diet and hydration. Constipation and strain in passing stool may cause bleeding in Hemorrhoid patients. Pregnancy and acute diarrheal illness also increases the risk of hemorrhoid formation.
• Restricting constipation also lessens the physical hazards that cause blood in stool like diverticulosis, and outpouchings in the colon.
• Alcoholism may increase the risk of rectal bleeding. It irritates the lining of the GI tract, and decreases the clotting capabilities of blood. So drinking alcohol must be avoided to prevent recurrence of hematochezia or blood in stool.

Hematochezia or blood in stool may arise due to multiple reasons; hence accurate diagnosis is necessary to detect the real reasons behind the problem. Different non-surgical and surgical treatments are available to prevent repetitive bleeding from lower gastrointestinal tract. Bleeding can also occur in upper gastrointestinal tract. Certain lifestyle changes and changes in eating habits can prevent or at least reduce recurrent bleeding after Hematochezia is detected and treated.