Blood in the stool means there is bleeding somewhere in your digestive tract. It may be a local bleed or may be bleeding from digestive tract (stomach, small/Large bowel) Bleeding may be associated with / without pain.

Common diseases which accounts for bleeding have been summarize below with their presentations.

  • PILES (HEMORRHOIDS) – One of the most common causes for lower Gastrointestinal bleed.

Presentation: Most of them are painless and often seen following passage of stool with quantity ranging from 2ml -100 ml /day.

Causes:  Most common – following constipation (passage of hard stool), during pregnancy,drug induced. Generally happens due to swelling of blood vessels (veins) along the anal canal and erosion to that leads to bleeding.

Most of the early piles are managed by medicines, but once get chronic (recurrent attacks) may need surgical cure.

  • FISSURE –IN –ANO – A small cut or tear in the tissue lining the anus similar to the cracks that occur in chapped lips or a paper cut.

Presentation: Always be associated with pain while passage of stool.

Bleeding is not much as seen in Piles (Generally stool is blood stained, with few drops of blood following passage of stool.

Causes: Passage of hard stool, following constipation, during pregnancy, prolong immobilization(Bed ridden patients, local injury.

Generally get cured with medicines and lifestyle modifications, may need surgical cure when becomes chronic/severe pain with bleeding.

  • FISTULA-IN-ANO - An ano-rectal fistula (Fistula-in-Ano) is an abnormal communication between the anus and the Peri-anal skin.

Causes: Anal canal glands situated in anal canal afford a path for infecting organisms to reach the intramuscular spaces. Fistulas can occur spontaneously or secondary to a Peri-anal (or Peri-rectal) abscess.

Presentations: Mucus/ pus discharge from inside of anus or from surrounding skin of anus,associated with / without pain

  • DIVERTICULAR DISEASE- Diverticula are small pouches that project from the colon wall. Usually diverticula don't cause problems, but sometimes they can bleed or become infected, then require surgical care.
  • COLITIS  - Inflammation of the colon.Among the more common causes are infections or inflammatory bowel disease (Autoimmune causes), namely Ulcerative colitis /Crohns diseases.

Managed with Immuno-suppressant medicines, but may require surgery when gets complicated / cancerous changes.

  • POLYPS:These are out pouching of mucosa of anal canal, when get eroded with hard stool causes bleeding. Polyps may be simple or may be cancerous.
  • CANCERS OF ANAL CANAL: Mostly seen after age of forty. May present with active bleeding (mostly painless) or present as occult bleeding (patient presents with Anemia (low hemoglobin), and on stool examination shows presence of RBCs (blood cells). Few patients present  as recent  onset of constipation, particularly who didn’t had constipation before.

Basic Evaluation Needed: Local examination of area by Physician, Chemical Tests of stool for Occult (Hidden) bleeding, Colonoscopy (scope passed from anus up to junction of small and large bowel to see entire colon and part of small intestine. Scanning (CT Scan/MRI) may be helpful following colonoscopy if suspicion of cancer arises.

Courtesy: Dr. Kumar Parth
(MBBS; MNAMS; FMAS; FAIS; FACRSI  (Colo-Rectal Surgery)
DNB; FSGE (Surgical Gastroenterology)
Consultant Surgical Gastroenterologist (Bangalore),, WWW.DRPARTHGASTRO.COM