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Blood in Stools: When Should You Worry?

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Discovering blood in your stools can be a distressing experience. While it’s natural to be concerned, not all cases of blood in stools are cause for alarm. In this article, we will delve into the various causes of blood in stools and explore when you should be concerned about this symptom.

It’s essential to understand that while some causes are minor and self-limiting, others may signal a more serious underlying condition.

Understanding Hematochezia and Melena

Before delving into the causes, it’s important to differentiate between two types of blood in stools: hematochezia and melena.

  • Hematochezia – Hematochezia refers to the passage of bright red blood in stools. This often indicates bleeding from the lower gastrointestinal tract, including the colon, rectum, or anus.
  • Melena – Melena, on the other hand, describes jet-black, tarry stools that result from bleeding in the upper digestive tract, typically in the stomach or small intestine.

Now, let’s explore the potential causes of each type of blood in stools and when you should be concerned.

Hematochezia Common Causes

Hematochezia, or bright red blood in stools, can have a range of causes. While some are relatively benign, others require immediate medical attention.


Hemorrhoids are swollen tissues in the rectum or anus due to engorged veins. They can bleed when strained during bowel movements, resulting in bright red blood on toilet paper or in the toilet bowl.

When to Worry: Hemorrhoids are usually not a cause for concern and can often be managed with lifestyle changes and over-the-counter treatments. However, if they cause severe pain, or if the bleeding is persistent or excessive, it’s advisable to seek medical evaluation.

Anal Fissures

Anal fissures are small tears or cracks in the lining of the anus. They can cause pain during bowel movements and may result in bright red blood on the stool or toilet paper.

When to Worry: While anal fissures are generally not serious, recurrent or persistent fissures may require medical attention. Consult a healthcare provider if you experience frequent anal fissures or if they do not heal.

Gastrointestinal Infections

Infections, such as gastroenteritis, can lead to inflammation and irritation in the digestive tract, resulting in blood in stools. This blood is usually bright red.

When to Worry: In most cases, infections causing blood in stools resolve on their own. However, if you experience severe symptoms like dehydration, high fever, or persistent diarrhea with blood, seek medical care promptly.

Diverticular Disease

Diverticula are small pouches that can form in the walls of the colon. When these pouches become inflamed or if the vessels there erode, it can lead to hematochezia.

When to Worry: Diverticulitis, which is the infection of these pouches, can cause fever and pain and requires immediate medical treatment. If you have a known history of diverticular disease and experience severe abdominal pain, fever with blood in stools, seek immediate medical attention.

Colon Polyps

Colon polyps are small growths that can develop in the lining of the colon. While most are benign, some can bleed, resulting in hematochezia.

When to Worry: Regular screening for colon polyps is essential, as they may develop into cancer over time. If you notice blood in stools and have not had a recent colonoscopy, it’s advisable to consult a healthcare provider.

Melena Serious Causes

Melena, characterized by jet black, tarry stools, typically indicates bleeding higher up in the digestive tract. It is often associated with more serious conditions that require prompt medical evaluation.

Peptic Ulcers

Peptic ulcers are open sores that can develop in the lining of the stomach or the upper part of the small intestine. When these ulcers bleed, the blood passes slowly down the gastrointestinal tract and gets oxidized, turning into blackish melena.

When to Worry: Peptic ulcers can lead to severe complications if left untreated. If you experience melena (and are not taking iron tablets), seek immediate medical attention.

Gastrointestinal Bleeding

Various gastrointestinal conditions, such as gastritis, esophagitis, or vascular malformations, can lead to gastrointestinal bleeding, causing melena.

When to Worry: Melena is a concerning symptom, and its underlying cause should be promptly investigated by a healthcare professional.

Blood-Thinning Medications

Certain medications, such as anticoagulants, and nonsteroidal anti-inflammatory drugs (NSAIDs), can increase the risk of gastrointestinal bleeding, leading to melena.

When to Worry: If you are taking blood-thinning medications and experience melena or any signs of bleeding, consult your healthcare provider immediately.

Esophageal Varices

Esophageal varices are enlarged veins in the lower part of the esophagus, often associated with liver disease. When these veins rupture, it can lead to melena. These can also cause a massive bleed that flows fast down the gastrointestinal tract, eventually leading to bright red blood in stools.

When to Worry: Esophageal varices bleeding is a medical emergency. If you suspect this condition due to risk factors like liver disease, seek immediate medical attention.

When Should You Seek Medical Attention?

Blood in stools, whether bright red (hematochezia) or dark and tarry (melena), should not be ignored. While some causes may be minor and self-limiting, others can indicate serious underlying conditions.

Here are some general guidelines to help you determine when to seek medical attention:

  • Persistent Bleeding – If you notice blood in your stools that persists for more than a few days, it’s important to consult a healthcare provider.
  • Excessive Bleeding – If the bleeding is excessive, such as large amounts of bright red blood or a significant amount of melena, seek immediate medical attention.
  • Associated Symptoms – Pay attention to accompanying symptoms, such as abdominal pain, changes in bowel habits, weakness, dizziness, or unexplained weight loss. These may warrant medical evaluation.
  • Medication Use – If you are taking medications that increase the risk of gastrointestinal bleeding, be vigilant about any signs of bleeding and consult your healthcare provider promptly.
  • Previous History – Individuals with a history of gastrointestinal conditions, bleeding disorders, or liver disease should be especially cautious and consult a healthcare provider if they notice blood in stools.
  • Age and Risk Factors – Age and risk factors, such as a family history of colorectal cancer, can influence the urgency of seeking medical attention. Consult with your healthcare provider to assess your individual risk.

Seeking Medical Evaluation

When you seek medical evaluation for blood in stools, your healthcare provider will typically follow a systematic approach to diagnose the underlying cause. This may involve:

  • Medical History – Your healthcare provider will inquire about your medical history, including any previous gastrointestinal issues, medications you are taking, and your family’s medical history.
  • Physical Examination – A physical examination may be conducted to assess your overall health and look for signs of bleeding or other abnormalities.
  • Stool Tests – Stool samples may be collected and analyzed for the presence of blood, infections, or other abnormalities. This may include fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT).
  • Endoscopic Procedures – Depending on the suspected cause and severity of the bleeding, your healthcare provider may recommend endoscopic procedures such as colonoscopy or upper endoscopy (esophagogastroduodenoscopy or EGD). These procedures allow for direct visualization of the gastrointestinal tract and may include biopsy or treatment of abnormalities found.
  • Imaging Studies – In some cases, imaging studies like abdominal CT scans, MRI scans, or angiography may be necessary to locate the source of bleeding and assess the extent of the problem.
  • Blood Tests – Blood tests may be conducted to assess your hemoglobin levels, which can help determine the extent of blood loss and the need for blood transfusions. These tests may also identify blood disorders that may increase the propensity for bleeding.
  • Specialized Testing – Depending on the findings and suspected causes, additional specialized tests or consultations with gastroenterologists or other specialists may be required.

Treatment and Follow-Up

Treatment for blood in stools will depend on the underlying cause. Once the cause is identified, your healthcare provider will recommend an appropriate treatment plan. This may include:

  • Medications – Medications may be prescribed to treat specific conditions causing the bleeding, such as antibiotics for infections, proton pump inhibitors for ulcers, or medications to manage bleeding disorders.
  • Lifestyle Changes – In some cases, lifestyle changes such as dietary modifications, managing stress, or discontinuing medications that contribute to bleeding risk may be advised.
  • Endoscopic Interventions – Procedures like endoscopic therapy, banding, injections or cauterization may be performed to treat conditions like bleeding ulcers or varices.
  • Surgery – In severe cases or when other treatments are ineffective, surgery may be necessary to address the cause of the bleeding. This may involve the removal of polyps, repair of damaged blood vessels, or surgery to treat underlying conditions.
  • Regular Monitoring – For some conditions, regular monitoring and follow-up appointments will be scheduled to ensure that treatment is effective and that there is no recurrence of bleeding.

Prevention and Health Maintenance

Preventing future episodes of blood in stools may involve adopting a healthier lifestyle and managing underlying conditions. Here are some preventive measures:

  • Healthy Diet – Consume a balanced diet rich in fiber, fruits, and vegetables. Limit spicy or irritating foods if you have a sensitive digestive tract.
  • Hydration – Stay well-hydrated to maintain healthy bowel function.
  • Medication Management – If you are on medications that increase the risk of gastrointestinal bleeding, discuss alternative treatments or ways to minimize their impact with your healthcare provider.
  • Stress Management – Stress can exacerbate gastrointestinal issues. Practice stress-reduction techniques such as mindfulness, meditation, or yoga.
  • Regular Check-Ups – Maintain regular check-ups with your healthcare provider, especially if you have a family history of gastrointestinal conditions.
  • Screenings – If you are at an age or have risk factors that necessitate screenings for colorectal cancer, adhere to the recommended screening schedule.


Blood in stools can be a disconcerting symptom, but it is essential to approach it with a proactive mindset. While some causes may be relatively harmless, others can indicate serious underlying conditions that require prompt medical attention. Recognizing when to worry about blood in stools and seeking appropriate evaluation and treatment can be a lifesaving decision.

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