Recognize blood in the stool
Blood in the stool can be bright red, maroon in color, black, and tarry, or occult (not visible to the naked eye). Examples of causes of blood in the stool are:
• Anal fissures
• Crohn’s disease
• Ulcerative colitis
• Anal cancer
Blood in the stool should be evaluated by a health care professional.
Healthy hemorrhoidal tissue cannot be seen since they must first swell and become inflamed or develop a clot to cause symptoms. One can see swollen external hemorrhoids or internal prolapsed hemorrhoids exposed outside the anus, but internal hemorrhoids cannot be seen because they remain inside the anus. A thrombosed hemorrhoid will appear as a lump at the anal verge, protruding from the anus, and will be dark bluish because of the blood clot contained inside the swollen blood vessel. Non-thrombosed hemorrhoids will appear as a rubbery lump. Often more than one swollen hemorrhoid appears at the same time.
While the presence of hemorrhoids is a reflection of the normal anatomy, most people and care professionals refer to hemorrhoids as an abnormal finding because they only present when they swell and cause problems.
Hemorrhoid swelling occurs when there is an increase in the pressure in the small vessels that make up hemorrhoids, causing them to swell and engorge with blood. This causes them to increase in size leading to symptoms. A variety of factors may cause increased pressure:
• Low-fiber diet and smaller caliber stool cause a person to strain when having a bowel movement, increasing the blood vessels’ pressure.
• Pregnancy is associated with hemorrhoid swelling and is likely due to increased pressure of the enlarged uterus on the rectum and anus. Also, hormonal changes with pregnancy may weaken the muscles that support the rectum and anus.
• Prolonged sitting on the toilet may increase pressure within the hemorrhoid blood vessels.
• Diarrhea, both acute and chronic
• Colon cancer
• Previous rectal surgery
• Spinal cord injury and lack of erect posture
Hemorrhoids are the most common cause of rectal and anal complaints. The most common complaint symptoms are:
• painless bleeding from the anal area,
• anal itching,
• pain in the anal area,
• swelling and feeling a lump at the anus are all associated with inflamed hemorrhoids.
It is important to remember that rectal bleeding or blood in the stool is never normal and, while it may come from a relatively benign cause like hemorrhoids, more serious causes can be life-threatening. These include bleeding from ulcers, diverticulitis, inflammatory bowel disease, and tumors. If rectal bleeding occurs, it is essential to contact your health care professional or seek emergency medical care. This is especially important if the person is taking blood-thinning medications.
When internal hemorrhoid becomes inflamed, it can cause swelling. This, in itself, does not cause pain because there are no pain fibers attached to the veins above the pectinate line. Passing a hard stool can scrape off the thinned lining of hemorrhoids, causing painless bleeding. However, swollen hemorrhoids can also cause spasm of the muscles that surround the rectum and anus, causing pain, especially if they protrude or prolapse through the anus. A lump can be felt at the anal verge. Internal hemorrhoids can also thrombose (clot), leading to severe pain.
Inflamed hemorrhoids can leak mucus, causing inflammation of the skin surrounding the anus, causing burning and itching, known as pruritis ani. However, other causes of itching include yeast and other skin infections and parasites like pinworms. Most importantly, just as blood in the stool should not be ignored because it might be a sign of colon cancer, anal itching or bleeding should not be presumed to be due to hemorrhoids because it can be a sign of anal cancer tumor.
External hemorrhoids behave differently since they are covered by “regular skin” and have pain fibers associated with them. A thrombosed external hemorrhoid occurs when an underlying vein within hemorrhoid clots off, causing intense pain from the rapid stretching of the skin covering hemorrhoids. A hard, painful lump can be felt at the anus. External hemorrhoids can also result in excess skin tags that can be felt at the anal verge and can cause difficulties with cleaning after a bowel movement, leading to secondary skin infections.
By reading this website, you acknowledge that you are responsible for your own health decisions. The information throughout this medical website is not intended to be taken as medical advice. The information provided is intended for general information regarding gastroenterology conditions and services.
If you are interested in finding out more, avoid worrisome self-diagnosis, please contact a Doral Health & Wellness specialist for a personal consultation. No information on this site should be used to diagnose, treat, prevent, or cure any disease or condition.