Hematochezia is generally seen in lower gastrointestinal bleeding, especially colon and rectum bleeding, but occasionally upper gastrointestinal bleeding can be seen. The color of blood in the stool depends on the location of the gastrointestinal bleeding, the amount of bleeding and the time the blood stays in the intestine. Blood in the stool accompanied by bleeding from the skin, mucous membranes or other organs is more common in blood system diseases and other systemic diseases. Such as leukemia, diffuse intravascular coagulation and so on.
What are the causes of blood in the stool?
The causes of hematochezia are systemic diseases and digestive tract diseases. Digestive tract diseases include upper digestive tract diseases and lower digestive tract diseases.
1. Systemic diseases
(1) Blood system diseases: such as primary or secondary thrombocytopenic purpura, leukemia, aplastic anemia, hemophilia, and diffuse intravascular coagulation caused by various reasons.
(2) Vitamin deficiency: vitamin K, vitamin C deficiency, etc.
(3) Acute infectious diseases: epidemic hemorrhagic fever, fulminant hepatitis, typhoid fever, paratyphoid fever, typhus, paracholera, bacillary dysentery, leptospirosis, neonatal sepsis, etc.
(4) Parasitic diseases: hookworm, schistosomiasis, tsutsugamushi and amoebic dysentery.
(5) Food allergy: such as milk protein allergy.
(6) Poisoning: plant poisoning, chemical poisons, uremia, etc.
(7) Connective tissue diseases: systemic lupus erythematosus, dermatomyositis and polyarteritis nodosa, etc.
(8) Adverse drug reactions: the most common analgesics, such as aspirin, indomethacin (indomethacin), piroxicam (yantongxikang), ibuprofen, etc.
2. Upper gastrointestinal diseases
(1) Esophageal diseases: bleeding from esophageal varices, esophagitis, esophageal cancer, etc.
(2) Gastroduodenal and biliary tract diseases: gastroduodenal ulcer, acute gastritis, biliary bleeding, tumor bleeding, etc.
3. Lower gastrointestinal diseases
(1) Anal diseases: hemorrhoids, anal fissure, anal fistula, etc.
(2) Rectal diseases: rectal inflammation (ulcerative colitis, radiation proctitis, etc.), rectal tumors (carcinoma, carcinoid, papillary adenoma, polyps, etc.), rectal injury (foreign body, stab wound, hard fecal abrasion , Equipment and biopsy causing injury, etc.).
(3) Colon disease: infection and parasites (bacterial dysentery, amoebic enteropathy, schistosomiasis, etc.), inflammation (ulcerative colitis, Crohn's disease, radiation colitis, colonic diverticulitis and diverticulum ulcer, etc.) , Tumors (colon cancer, malignant lymphoma, leiomyoma, fibrosarcoma, etc.).
(4) Small bowel diseases: infection (typhoid fever and paratyphoid fever, etc.), inflammation (acute hemorrhagic necrotizing enteritis, Crohn’s disease, diverticulitis and diverticulum ulcer), tumors (malignant lymphoma, carcinoma, leiomyosarcoma, hemangioma, etc.) ).
PS: Ten diseases that cause blood in the stool
(1) Hemorrhoids or anal fissure, anal fistula
The blood color is generally bright red, and does not mix with feces, and does not contain mucus. It is manifested as dripping of fresh blood after stool, which is more likely to occur when indurated stool.
(2) Bacterial dysentery
Stools are often pus and blood samples, and the amount is not much each time, often accompanied by tenesmus; the chronic phase is intermittent mucus, pus and blood in the stool.
(3) Amoebic dysentery
Stools are mostly jam-like, or dark red, with a large amount, often accompanied by purulent mucus. Patients often have fever, abdominal distension, abdominal pain, and tenesmus.
A history of exposure to infected water, often manifested as chronic diarrhea, stools with pus and blood or stools with blood.
(5) Ulcerative colitis
Abdominal pain and diarrhea are present during the attack, often accompanied by tenesmus. Stools are generally mucus, pus, and bloody stools, and severe cases can be bloody and watery stools.
Excreting mucus and blood in the stool, often without stool.
(7) Rectal cancer
If you suffer from chronic diarrhea or have recurrent mucus, pus, and bloody stools, accompanied by tenesmus, and the general anti-inflammatory treatment fails, you should consider the possibility of rectal cancer.
(8) Colon cancer
Stool becomes thin, and the stool is accompanied by mucus, pus and blood, and colon cancer may be suspected. A few patients may only show fixed abdominal pain.
(9) Rectal and colon polyps
Polyps in the rectum, sigmoid colon or descending colon are characterized by fresh blood attached to the stool, which is characterized by immiscibility of blood and stool.
(10) Gastric cancer, gastric and duodenal ulcers, acute erosive gastritis, etc., all or part of the stool is mostly tarry.
How to identify quickly?
Blood in the stool is generally divided into three forms: stool with blood, or all stools with blood, and the color is bright red, dark red or tarry. These three color forms are just like the three primary colors of "red, yellow and blue" in real life. I call them the "three primary colors of blood in stool-black, dark, and red".
1. Tarry stools (black)
It should appear in the upper digestive tract-near the stomach and duodenum. It is called "tarmac" because it stays in the intestine for a long time after bleeding from the upper gastrointestinal tract or small intestine, red blood cells are destroyed, hemoglobin combines with sulfide in the intestine to form ferrous sulfide, making the stool look black. Sometimes the stool is shiny with mucus, similar to asphalt.
(1) Persistent pain + hematemesis + melena may be gastric cancer
A small number of patients with early gastric cancer have nausea, vomiting or upper gastrointestinal symptoms similar to ulcer disease. Pain and weight loss are the most common clinical symptoms of advanced gastric cancer. Patients often have clear upper gastrointestinal symptoms, such as upper abdominal discomfort, fullness after eating, upper abdominal pain aggravated as the disease progresses, decreased appetite, and fatigue. Patients with advanced gastric cancer often have symptoms such as anemia, weight loss, malnutrition and even cachexia.
(2) Periodic upper abdominal pain + melena may be gastric ulcer
Stomach ulcer is a common digestive tract disease, and upper abdominal pain is its main symptom. The pain is mostly located in the upper abdomen, but can also appear in the upper left abdomen or behind the sternum and xiphoid process. It often presents dull pain, dull pain, swelling pain, and burning pain. The pain of gastric ulcer usually relieves gradually after 1 to 2 hours after a meal, until the above rhythm reappears after the next meal. Some patients may be asymptomatic, or have complications such as bleeding, melena, or gastric perforation as the first symptoms.
(3) Hematemesis + melena may be acute erosive gastritis
Acute erosive gastritis has a rapid onset and may cause sudden upper gastrointestinal bleeding. Manifestations of hematemesis and melena are rare in people who have melena alone. Bleeding is often intermittent. Heavy bleeding can cause syncope or shock, anemia. There will be dull discomfort or tenderness in the upper abdomen when bleeding.
(4) Upper abdominal pain + hunger pain + melena may be duodenal ulcer
It manifests as pain in the upper abdomen, which can be dull pain, burning pain, swelling pain or severe pain, or only a dull pain and discomfort when hungry. The typical performance is mild or moderate persistent pain under the xiphoid process. Complications such as bleeding, perforation, and pyloric obstruction can occur. If bleeding occurs, it can cause melena.
2. Pus and blood in the stool (dark)
Dark colored stool is pus and blood stool, which refers to both pus and blood in the excreted stool. The blood is thin in appearance and sometimes contains a lot of mucus. Dark colored stools or bloody stools containing mucus are often found in tumors and inflammations in the rectum or colon, such as:
(1) Continuous difficulty in defecation + tenesmus + constipation/diarrhea + dark stools may be rectal cancer
Early rectal cancer is mostly asymptomatic, but with the growth of colorectal cancer, problems such as changes in bowel habits, bloody stools, pus and bloody stools, tenesmus, constipation and diarrhea will occur to a certain extent. In the later stage, rectal cancer will gradually thin the stool, and in the later stage, there will be defecation obstruction, weight loss and even cachexia.
(2) Jam type + difficulty defecation + dark colored stool may be colon cancer
Divided into left and right colon cancer, patients with colon cancer early manifested as abdominal distension and indigestion, and then changed bowel habits, abdominal pain before defecation, and later appeared mucus or mucous purulent bloody stool. After tumor ulceration, blood loss, and toxin absorption, poisoning symptoms such as anemia, low fever, fatigue, weight loss, and edema often appear.
(3) Pain + tenesmus + diarrhea + vomiting + dark colored stool may be ulcerative colitis
The initial manifestations of ulcerative colitis can take many forms. Bloody diarrhea is the most common early symptom. Other symptoms include abdominal pain, blood in the stool, weight loss, tenesmus, and vomiting. Occasionally the main manifestations are arthritis, iridocyclitis, liver dysfunction and skin lesions. Fever is a relatively uncommon symptom. In most patients, the disease is chronic, and in a few patients, it presents an acute and catastrophic outbreak. These patients show frequent bloody stools, up to 30 times a day with high fever and abdominal pain.
(4) Diarrhea + abdominal pain + dark color may be multiple intestinal polyps
Multiple intestinal polyps are also called familial adenomatous polyposis. Multiple polyps are mostly related to genetics, diet, and inflammatory factors, and the early symptoms are not obvious. Common symptoms include diarrhea, abdominal pain, and blood in the stool. Blood in the stool often persists, accompanied by malignant changes in the later stage. If a secondary infection occurs, the above symptoms will be aggravated, with loose stools, smelly, foamy, and sometimes mucus, pus and blood. There are also constipation associated with tenesmus. In addition, if a large tumor is located at the lower end of the rectum, it can protrude outside the anus after feces, showing a dark red, papillary mass.
3. Bloody stool (red)
Red stools are bloody stools, and most of the red stools are acute bleeding. The blood flows out of the blood vessels for a short time and is discharged with the stool through the anus, or it flows out directly after the stool. The blood flowing out looks similar to traumatic bleeding, bright red or purplish red, dark red, and can coagulate into blood clots after a while. Bloody stools generally come from anorectal diseases, such as:
(1) Splashing/dripping + painless + bright red may be hemorrhoids
Hemorrhoids are the most common disease in anorectal department. Different stages of internal and external hemorrhoids and mixed hemorrhoids can cause fecal bleeding. Generally, the stool is accompanied by fresh blood or dripping blood after the stool. In severe cases, splashing blood may appear. It should be noted that external hemorrhoids generally have no stool bleeding.
(2) Painless + blood and feces do not mix + bright red may be rectal polyps
The typical symptom of a low rectal polyp is painless stool bleeding. Bleeding during defecation, stop after defecation, the amount varies, generally blood does not mix with stool. Of course, if the polyps are high and numerous, sometimes the blood will mix with the feces.
(3) Wipe/drip + pain during stool + bright red may be anal fissure
It manifests as pain in the anus during defecation and lasts for a while after defecation. At the same time, it is accompanied by blood in the stool. The bleeding method is that there is blood on the side of the stool, which does not mix with the stool. Some patients drip or wipe blood after the stool.
(4) Swelling + falling sensation + constipation + bright red may be rectal prolapse
The main symptom of rectal prolapse is the prolapse of a mass from the anus. As the prolapse worsens, different degrees of anal incontinence are caused, and mucus often flows out, leading to eczema and itching of the perianal skin. Due to difficulty in emptying the rectum, constipation often occurs, and stools increase frequently, which looks like sheep feces. The mucous membrane is eroded and blood flows out after ulceration.
So is it enough to only rely on the common features of the disease to identify the disease? Not really. No matter how obvious the symptoms are, it is wrong to rely solely on experience or words before the diagnosis, and more attention should be paid to the specific characteristics of the disease itself. The middle number of the text is only for ease of presentation, not absolute. Once you find symptoms in your body, you should go to the hospital for medical treatment in time to identify the symptoms to avoid delays in your condition.