Discovering blood in your stool can be an alarming experience, and it’s completely normal to feel concerned. While it’s not always a sign of a more serious problem, the presence of blood is definitely not something to ignore. The appearance can vary from bright red streaks to darker, tar-like substances, and these different presentations can offer clues about what’s happening inside your body. The potential causes span a wide range, from common issues like hemorrhoids to more serious conditions such as inflammatory bowel disease or even cancer.

What to Look For

Actually discovering blood in your stool can be tricky, in part because not everyone is used to or comfortable with examining the contents of their toilet after a bowel movement. But since the presence of blood may not be immediately obvious or clear, it often requires a closer examination to look for key signs:1

  • Color: Changes in color can be an indicator of blood, and that includes colors other than bright red blood. Bloody stools can also be black, maroon, or various shades of brown with streaks of dark red.
  • Consistency: The presence of blood can also change the consistency of your stool, such as making them more sticky or tarry; tarry stools, for instance, are often associated with bleeding higher up in the digestive system.
  • Toilet bowl water: If the stool itself isn’t especially bloody looking, the water in the toilet bowl may give a hint if it is pinkish or there are actual drops of blood.
  • Toilet paper: Similarly, the stool may look normal but there are streaks of red on the toilet paper after wiping.
  • Frequency: The frequency with which blood appears is also important because it can be an indicator of the underlying problem causing the bleeding.
  • Amount: If you’ve already noticed blood in your stool, the amount of blood present can also provide insight into the cause.

Many people might have blood in their stool and no other symptoms, which is also why blood can be present and not noticed. Depending on the underlying cause, however, there are a variety of other symptoms that may be experienced. Changes in bowel habits are fairly common, including diarrhea and constipation. Fatigue, weakness, and a light-headed feeling are also common if the bleeding is chronic or severe; this is likely due to anemia from loss of blood. Other possible symptoms include abdominal pain, bloating, and bowel urgency.

Most Common Causes of Blood in Stool

There are numerous possible causes for why blood may appear in stool, including the possibility that it’s not actually blood; foods with red pigment like beets, candy, or gelatin can temporarily make poop look red, for example. But if the cause is actually gastrointestinal bleeding, there are a variety of conditions that may be an underlying cause:2

  • Hemorrhoids: Hemorrhoids are swollen veins that can appear generally either inside the rectum or around the outside of the anus. When irritated, they can bleed, typically causing bright red blood on toilet paper or in the bowl.
  • Anal fissures: Sometimes when straining to pass large or especially hard stools, the lining of the anus can get small tears. These anal fissures can cause sharp pain during bowel movements and may bleed, resulting in bright red blood on the stool or toilet paper.
  • Inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis, the two principal types of IBD, can affect various parts of the digestive tract (though usually the large intestine) and result in bleeding.
  • Colon polyps: Polyps are small abnormalities on the inner lining of the colon or rectum that have the potential to become colon cancer. Even when benign, though, they can bleed.
  • Colorectal cancer: Colorectal cancer typically takes many years to develop, and blood in the stool is one of the first symptoms to emerge.
  • Diverticular disease: Diverticula are small pouches that can form in the colon wall (diverticulosis), and they can cause bleeding when they become inflamed or infected (diverticulitis).
  • Stomach ulcers: Peptic ulcers are essentially open sores in the lining of the stomach or first part of the small intestine (duodenum). They can cause bleeding that appears as black, tarry stools.
  • Proctitis: Proctitis is the term for inflammation of the lining of the rectum that can cause rectal bleeding.
  • Infection: Some bacterial or parasitic infections can cause bloody diarrhea.

Getting Diagnosed

If you discover blood in your stool (and you can rule out benign reasons like red-colored foods), it’s best to seek medical attention sooner rather than later. After an initial physical examination and evaluation of family history, the gastroenterologist will want to run a series of tests to determine the underlying cause. One of the go-to diagnostic tools is called a fecal occult blood test; this involves testing fecal matter to see if blood hemoglobin is present even if it isn’t visually apparent.

Depending on the results, the next step is to determine the underlying cause. If upper GI bleeding is suspected, an endoscopy can be used to evaluate the esophagus and stomach. If lower GI bleeding seems to be more likely, a colonoscopy or sigmoidoscopy is used to investigate the large intestine. The specific combination of tests will be largely determined by the individual patient’s symptoms, age, and risk factors. Which tests are performed in what order is also influenced by how acute the bleeding is.3

Treatment Options

The treatment options will naturally depend heavily on the determination of an underlying cause as well as the overall health of the patient. The possibilities range from simple lifestyle changes to complex medical interventions. Many cases can be managed with dietary modifications, increased fiber intake, and over-the-counter medications. For more serious conditions, prescription drugs like anti-inflammatory and antibiotic medications may be used. In the most severe cases, surgery might be required.

When to See a Doctor

If you notice blood in your stool or on toilet paper, it's recommended that you seek help from a healthcare provider, especially if it is persistent; this is true even if the bleeding seems minor. At Cary Gastro, we are dedicated to providing excellent digestive healthcare and giving you peace of mind. We know it can be alarming to discover blood in the toilet, but our experienced and compassionate staff are there to take care of you. Please contact us today to request an appointment.


1https://www.mdanderson.org/cancerwise/when-to-worry-about-blood-in-your-stool.h00-159545268.html
2https://www.ncbi.nlm.nih.gov/books/NBK563143/
3https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding/diagnosis