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Blood in Stools – what does it mean?

Blood in stool means there is bleeding somewhere in your digestive tract. Though this means there is something wrong, it could be caused by a number of factors, ranging from the relatively harmless piles or anal fissures, to the more serious, such as colorectal cancer.

What can blood in stools mean? Is it a symptom of cancer?

Blood in stools is a sign of a colorectal abnormality. Normal stools do not have any blood. The most common cause is haemorrhoids, also known as Piles. Other common causes of blood in stools include:

  • Anal fissure – a small tear in the lining of the anus
  • Diverticulosis – small, bulging pouches that develop in your digestive tract. If these pouches become inflamed or infected, it is known as diverticulitis.
  • Inflammatory bowel disease
  • Proctitis – inflammation of the rectum and anus.
  • Angiodysplasia – causes swollen or enlarged blood vessels, as well as the formation of bleeding lesions in the colon
  • Colitis – inflammation of the inner lining of the colon
  • Polyps – Small clumps of cells that form on the lining of the colon can cause bleeding.
  • Colorectal cancer – tumors of the esophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.

It is almost impossible to differentiate between these conditions. Though the most common cause of blood in stools is haemorrhoids, having blood in stools is particularly worrying as it can be a sign of the most common cancer in Singapore – colorectal cancer.

When should I be concerned about this and see a doctor?

You should always be concerned when you see blood in stools as this is never normal. You should always see a doctor to examine you and possibly refer you to a specialist to confirm the cause of the bleeding. Most causes of bleeding can be treated with medication and sometimes surgery.

What will the doctor do to diagnose the problem?

All doctors can and should perform a bedside procedure called proctoscopy (examination of the rectum and anus) to examine for conditions like haemorrhoids and anal fissures. Even if haemorrhoids are seen on proctoscopy, the other parts of the colon and rectum need to be examined to determine the exact cause of bleeding.

Hence most doctors will refer to a specialist, who will perform a colonoscopy. A colonoscopy is the gold standard to evaluate the entire colon and rectum. The main advantage of a colonoscopy over other tests is that it is both diagnostic and therapeutic. In other words, it can both diagnose and potentially treat the problem. For example, a biopsy of any abnormality can be obtained and sent for histology for confirmation, and polyps can be removed during the colonoscopy.

How can I prevent blood in stools?

If the cause of bleeding is confirmed to be haemorrhoids only (the most common cause), then certain lifestyle changes can help.

Taking enough fibre and drinking a lot of water, and exercise regularly. This will help prevent constipation and straining during bowel movements. Limiting the time on the toilet bowl to 5-10 minutes and not taking distracting mobile devices into the toilet. The longer the stay in the toilet, the worse the haemorrhoids.

Dr Leong Quor Meng Colorectal General Surgeon

Dr Leong Quor Meng
Colorectal & General Surgeon
Nobel Surgery Centre

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