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What Causes Red Stool?

Red stool can be a symptom of internal bleeding and may come with uncomfortable symptoms.

What’s causing your red stool

Seeing reddish stool in the toilet after a bowel movement can be disconcerting. But often it’s caused by red food (tomatoes and beets), dyes, and over-the-counter products. In particular, bismuth, an ingredient in antacids like Pepto-Bismol, might give stool a reddish tint.

But it can also be a sign that you’re bleeding. Bright red streaks on toilet paper or in the toilet may be caused by hemorrhoids or anal fissures, especially when accompanied by anal pain or itching. Or an inflammation in the intestines, from inflammatory bowel disease.

Red stool may also be caused by internal bleeding in the digestive tract, and in some cases, colon cancer. If red stool is accompanied by symptoms like fever, abdominal or rectal discomfort, weight loss, nausea, diarrhea, or vomiting, or blood seems clumpy like coffee grounds or uncontrollable after elimination, call a doctor.

What is causing your red stool?

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1. Hemorrhoids

Pro Tip

If you have reddish stools, the most important thing is to figure out why. If it is not clearly related to your diet, if you have other health issues, your doctor will do a workup. —Dr. Shria Kumar

Symptoms

  • Painful elimination
  • Blood in stool or blood while wiping
  • Pain or itching around the anus
  • Feeling a lump near the anus

Hemorrhoids are swollen veins around the rectum and anus. They occur in nearly 5% of the U.S. population, and occur most commonly in people between 45 and 65.

They are often inflamed by constipation. When you’re constipated, straining to eliminate can irritate the hemorrhoids and cause them to bleed. Pregnancy can also cause hemorrhoids.

Using laxatives, staying well hydrated, and eating a high fiber diet can help relieve constipation.

Hemorrhoid cream can help you manage symptoms. In some cases, hemorrhoids may have to be surgically removed.

2. Anal fissure

Symptoms

Anal fissures are splits or tears in the part of the anus just outside of the body. They're very common—about 11% of people will have an anal fissure in their lifetime. They can occur after a bout of diarrhea or from constipation. Anal fissures can also occur because of anal sexual activity that may cause mild trauma to the anus, or from trauma to the anal area during childbirth.

Anal fissures usually get better on their own, but you may take laxatives to make passing stool less painful. Sitz baths (sitting waist deep in a bath of warm water, sometimes with baking soda added for additional soothing) can also help relieve the discomfort. Occasionally, a doctor may prescribe medication if the fissure doesn’t get better on its own.

3. GI bleeding

Symptoms

The digestive, or gastrointestinal (GI), tract includes the esophagus, stomach, small intestine, large intestine, rectum, and anus. In general, gastrointestinal bleeding does not just lead to reddish stool, but frank blood is seen (can be with clots), and is accompanied by other symptoms (such as abdominal pain, fatigue, lightheadedness, and weight loss).

GI bleeding that causes red stool is usually lower GI bleeding (from the large intestine, rectum, or anus), but really rapid upper GI bleeding can also cause it. Depending on its severity, it can be a medical emergency.

Causes of lower GI bleeding include diverticulosis, colitis, inflammatory bowel disease, colon polyps, or colon cancers. The treatment is targeted to the underlying cause.

4. Inflammatory bowel disease (Crohn's or colitis)

Symptoms

  • Fatigue
  • Fever
  • Bloody diarrhea
  • Weight loss
  • Mouth sores
  • Joint pains

Inflammatory bowel disease (IBD) is inflammation of the bowel. There are two types: Crohn’s disease or ulcerative colitis. It is caused by a complex interplay between genetics, the environment, and your body’s immune system. Early symptoms may develop gradually, or can occur suddenly.

Untreated, IBD causes inflammation throughout the digestive tract, which can lead to malnutrition, cancers, bleeding, and overall poor health. The goal of treatment is to eliminate inflammation. This is typically done through medication and diet.

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5. Colorectal cancer

Symptoms

  • Weight loss
  • Change in appetite
  • Change in bowel habits, often (but not always) with blood

Cancer of the colon (large intestine) or rectum is considered colorectal cancer. Colorectal cancer typically affects older adults (over age 50), but it can happen at any age. The cancers usually begin as small polyps, and over time, can become cancerous.

This is why colonoscopy screening is recommended: to find and remove these small polyps before they become cancerous. Colorectal cancer can cause a range of subtle and not so subtle symptoms, though usually there are some changes to your bowel habits and eating patterns.

Treatments include surgery, chemotherapy, and/or radiation.

Other possible causes of red stool

Dr. Rx

If you eat reddish tinted foods—beets, cranberries, and the like—you may not only notice reddish stools but darker urine as well. This is your body processing and expelling the byproducts of any food you consume—all normal! —Dr. Kumar

A number of conditions may also cause red stool, though these are either rare or red stool is not a main symptom.

  • In babies, Meckel’s diverticulum can cause blood in the stool.
  • Problems in the upper GI tract (esophagus, stomach, small intestine) can cause red blood, if the bleeding is brisk.

When to call the doctor

In general, if you experience it without a clear trigger (i.e., “I ate beets earlier today”), or if this is something that occurs more than once, you should call your doctor to discuss your symptoms.

Should I go to the ER for red stool?

Pro Tip

Red stool doesn’t necessarily indicate an emergency! —Dr. Kumar

You should go to the emergency department if you have any of these signs of a more serious problem.

  • Intense abdominal pain
  • High fever
  • Stool that looks clumpy, like coffee grounds
  • Bleeding that does not stop when you get up from the toilet
  • Dizziness, lightheadedness
  • Feeling faint
  • If you are on blood thinners

Red stool treatments

Treatment is dependent on the cause. If you are having reddish stool based on your diet, no intervention is needed, and you do not need to stop eating those foods.

If you are bleeding, then the treatment is directed at the cause of the bleeding (i.e., hemorrhoid cream and treating constipation for hemorrhoids, or sitz baths and ensuring soft stools for anal fissures).

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