Blood in Stool: When Should You Be Worried?

What Does Blood in Stool Look Like?

Blood in stool can appear in different ways. Recognising these differences can support you in understanding the potential source of bleeding and when to seek medical advice.

• Bright Red Blood:

  Bright red blood may be seen on toilet paper or in the toilet bowl. This usually suggests bleeding from the lower digestive tract, such as haemorrhoids or anal fissures.

• Dark Red or Maroon Blood:

  When the blood appears dark red or maroon, it may indicate bleeding higher up in the colon or small intestine.

• Black, Tarry Stools (Melena):

  Black, tar-like stools often signal bleeding in the upper digestive tract, such as the stomach or oesophagus, and require prompt medical attention.

Common Causes of Blood in Stool

Keep reading to learn some of the most common reasons for rectal bleeding and why timely medical attention is important.

Haemorrhoids

Haemorrhoids are swollen blood vessels in the anus or rectum. They are especially common in individuals with chronic constipation or during pregnancy and often cause bright red bleeding during bowel movements.

Anal Fissures

Anal fissures are small tears in the skin of the anus that are usually caused by passing hard or large stools. They can lead to sharp pain and visible streaks of blood on toilet paper.

Diverticular Disease

Diverticular disease is a condition where small pouches (diverticula) form in the colon wall, primarily caused by a low-fibre diet and straining during bowel movements. When the diverticula become inflamed or irritated, they may cause painless but noticeable bleeding.

Inflammatory Bowel Disease (IBD)

Inflammatory bowel diseases (IBD), such as Crohn's disease and ulcerative colitis, are a group of chronic conditions that cause persistent inflammation of the digestive tract. This ongoing inflammation can result in symptoms like bleeding, diarrhoea and abdominal pain.

Colorectal Polyps or Cancer

Polyps are growths within the colon that can lead to bleeding. While many are harmless, some might develop into cancer if left untreated. Persistent or unexplained bleeding could also indicate colorectal cancer, which requires prompt medical evaluation.

When Should You Be Worried?

Colorectal specialists advise consulting a doctor right away if you notice any of the following:

• Persistent or recurring bleeding
• Unexplained weight loss
• Changes in bowel habits (constipation, diarrhoea or stools becoming narrower than usual)
• Abdominal pain (cramping, bloating or persistent discomfort)
• Anaemia or fatigue

Diagnosis and Tests

Determining the exact cause of rectal bleeding requires a comprehensive evaluation by a specialist. At our clinic, we offer a range of diagnostic tests to ensure accurate results:

• Physical Examination:

  A careful assessment of the anal and rectal area is performed first to identify visible causes such as haemorrhoids or fissures.

• Colonoscopy:

  The procedure allows direct visualisation of the entire colon to detect polyps, inflammation or cancer.

• Stool Tests:

  In some cases, stool tests might be ordered to detect hidden (occult) blood or signs of infection that aren’t visible to the naked eye.

• CT Colonography or Sigmoidoscopy:

  These imaging and endoscopic tests are performed when further evaluation of specific sections of the colon is needed.

Treatment Options

The treatment for rectal bleeding varies depending on the underlying condition. Identifying and addressing the specific issue not only helps relieve symptoms but also reduces the risk of complications.

Haemorrhoids and Anal Fissures

These anal conditions are usually managed with dietary changes to soften stools, topical creams for symptom relief, and, when necessary, minimally invasive procedures such as rubber band ligation or laser treatment.

Inflammatory Conditions

Conditions like Crohn’s disease or ulcerative colitis are treated with medication to control inflammation, along with regular monitoring to manage flare-ups and prevent further complications.

Polyps

Polyps detected during a colonoscopy are typically removed immediately, helping lower the risk of them becoming cancerous over time.

Colorectal Cancer

Treatment depends on the stage of the cancer and might involve surgery, chemotherapy, radiotherapy, or a combination of these approaches to achieve the best possible outcome.

Prevention and Regular Screening

Regular screening is one of the most effective ways to detect colorectal cancer early, increasing the chances of successful treatment. In Singapore, adults aged 50 and above are strongly encouraged to undergo routine screening through:

Faecal Immunochemical Test (FIT)

For those without known risk factors, a Faecal Immunochemical Test (FIT) is recommended once a year. This simple, non-invasive test detects hidden blood in the stool, which can be an early warning sign of colorectal cancer or other conditions.

Colonoscopy

If your FIT result is positive or you’re considered high-risk due to family history or other factors, a colonoscopy is advised, typically every 10 years. This procedure allows doctors to examine the colon directly and remove polyps before they become cancerous.

Subsidised screening is available under the Screen for Life programme, making preventive care more accessible to Singaporeans.

Although blood in your stool is often due to minor issues, it can sometimes signal colorectal cancer. The good news is that early detection and treatment can make a big difference. If you notice any warning signs, schedule a consultation with our Colorectal Surgeon, Dr Ho Kok Sun, for a thorough evaluation and personalised guidance.