Blood in Stool

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Blood in stool

Stools looks like strawberry jam

Stool looks like raspberry jelly

Poop looks like strawberry jam

Poo looks like currant jelly

Blood and mucus in stool

Stool looks like jelly

Bloody diarrhea

Red sticky poo

About the Symptom

Bloody stools describes a condition where blood can be seen in the stool. The blood may be fresh, bright red or clotted. It can be as minor as only visible on the paper all the way to mixed in with the stool or freely dripping from the anus.

When to See a Doctor

Seek professional care if you experience any of the following symptoms

Possible Causes

Generally, Blood in stool can be related to:

Related Serious Diseases

Sometimes, Blood in stool may be related to these serious diseases:

Doctor's Diagnostic Questions

Your doctor may ask these questions to check for this symptom:

Reviewed By:

Carlos Cuenca, MD

Carlos Cuenca, MD (General Surgery)

Dr. Cuenca graduated from Rutgers New Jersey Medical School. He is currently a categorical surgical resident at UC Davis Health.

Yoshinori Abe, MD

Yoshinori Abe, MD (Internal Medicine)

Dr. Abe graduated from The University of Tokyo School of Medicine in 2015. He completed his residency at the Tokyo Metropolitan Health and Longevity Medical Center. He co-founded Ubie, Inc. in May 2017, where he currently serves as CEO & product owner at Ubie. Since December 2019, he has been a member of the Special Committee for Activation of Research in Emergency AI of the Japanese Association for Acute Medicine. | | Dr. Abe has been elected in the 2020 Forbes 30 Under 30 Asia Healthcare & Science category.

From our team of 50+ doctors

Content updated on Jan 30, 2025

Following the Medical Content Editorial Policy

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FAQs

Q.

Petechiae in Women: What Those Tiny Red Dots Really Mean

A.

Petechiae in women are tiny flat red or purple dots from small bleeding under the skin; they are often harmless after coughing, vomiting, exercise, tight clothing, or hormonal changes, but can also reflect medication effects, vitamin or iron deficiencies, infections, low platelets, clotting disorders, liver disease, or blood cancers. There are several factors to consider, including paired symptoms like fever or unusual bleeding, when to contact a clinician, and what tests to expect; see below for important details that may change your next steps.

References:

* Cines DB, Bussel JB. Immune Thrombocytopenia in Women: Clinical Features, Therapeutic Challenges, and Future Directions. Semin Hematol. 2017 Jan;54(1):47-52. doi: 10.1053/j.seminhematol.2017.01.006. PMID: 28254133.

* Cohen R, Levy A, Varon D. An approach to the patient with purpura. Blood. 2017 Jan 5;129(1):15-21. doi: 10.1182/blood-2016-05-654060. PMID: 28052950.

* Arnold DM, Batchra K. Drug-induced immune thrombocytopenia. Platelets. 2022;33(5):715-724. doi: 10.1080/09537104.2021.1969300. Epub 2021 Sep 14. PMID: 34520338.

* George JN, Vesely SK. Thrombotic Microangiopathies and Women's Health. Semin Thromb Hemost. 2017 Mar;43(2):162-169. doi: 10.1055/s-0036-1593856. Epub 2016 Oct 27. PMID: 27788414.

* Goel R, Pal Singh H, Patel V, Patel D, Patel S, Khambhati J. Von Willebrand disease: a concise review for the consulting physician. Br J Haematol. 2024 Apr;204(4):1147-1159. doi: 10.1111/bjh.19230. Epub 2024 Feb 13. PMID: 38347895.

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Q.

Petechiae Over 65: Identifying Serious Blood Concerns

A.

In adults over 65, petechiae are tiny, non-blanching red or purple skin spots from capillary bleeding; while they can follow minor pressure, they may also signal medication effects, low platelets or clotting disorders, infections, or vascular or liver disease, especially if they appear suddenly, spread, or come with fever, fatigue, easy bruising, nosebleeds, or bleeding gums. There are several factors to consider; see below for urgent red flags, what doctors check, safe at home steps, and prevention tips that could affect your next healthcare steps.

References:

* Sostres B, Gilaberte Y, Alonso V. Differential diagnosis of purpura in older adults. Clin Interv Aging. 2018 Mar 22;13:485-492. doi: 10.2147/CIA.S154817. PMID: 29596328.

* Cuker A, Cines DB. Thrombocytopenia in the elderly. Semin Hematol. 2012 Jul;49(3):257-65. doi: 10.1053/j.seminhematol.2012.04.004. PMID: 22709663.

* Castaman G, Marcucci M, Arcudi E, Vianello S, Pagnan A. Bleeding disorders in the elderly patient: an updated review. Blood Transfus. 2022 Sep;20(5):401-411. doi: 10.2450/2022.0125-22. PMID: 35084940.

* Adhikari A, O'Connor SM, Komrokji RS. Myelodysplastic Syndromes: Diagnosis, Prognosis, and Treatment in the Elderly. Curr Oncol Rep. 2018 Aug 3;20(9):74. doi: 10.1007/s11912-018-0718-2. PMID: 29994627.

* Grivas P, Economopoulou P, Psaltopoulou T, Karkoulis P, Anagnostopoulos C. Hematological malignancies in the elderly: incidence, outcome, and new trends. Clin Interv Aging. 2014 Jul 18;9:1211-20. doi: 10.2147/CIA.S66710. PMID: 25056708.

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Q.

Bright Red vs. Dark Blood in Stool: When Should You Be Worried?

A.

Bright red blood on the paper, dripping, or as streaks on the stool usually comes from the rectum or anus and is often due to hemorrhoids or fissures; dark red, maroon, or black tar-like stool suggests bleeding higher in the digestive tract and is more urgent. There are several factors to consider. See below to understand more, including how the amount, frequency, and symptoms like dizziness, weakness, weight loss, abdominal pain, or bowel habit changes guide when to monitor, call a doctor, or seek urgent care.

References:

* Jara-Romero M, Khomvilai S, Vento-Garcia A, Singh I, Lunsford J, Gidwani R, Morkos M, Koya D, Bhardwaj A, Morkos A, Bhardwaj S. Hematochezia: A Clinical Review. Cureus. 2020 Jul 16;12(7):e9231. doi: 10.7759/cureus.9231. PMID: 32678696.

* Lara L, Gralnek IM. Upper Gastrointestinal Bleeding: An Updated Review. Clin Gastroenterol Hepatol. 2023 Apr;21(4):857-867. doi: 10.1016/j.cgh.2022.01.037. Epub 2022 Feb 2. PMID: 36720491.

* Vreeburg EM, ter Maaten JC, van Beek EJ. Distinguishing upper from lower gastrointestinal bleeding: a practical guide. Neth J Med. 2018 Mar;76(2):50-54. PMID: 29555776.

* Strate LL, Gralnek IM. Evaluation and Management of Acute Lower Gastrointestinal Bleeding: An Updated Review. Clin Gastroenterol Hepatol. 2022 Jan;20(1):31-43. doi: 10.1016/j.cgh.2021.08.038. Epub 2021 Sep 7. PMID: 34509749.

* Sung JJY, Lau JYW, Ching JYL, Chiu PWY, Gralnek IM, Hunt RHL, Kuipers EJ, Lanas A, Meltzer D, Rubin DT, Tergast TL, Wu JCC, van Leerdam ME. Acute Upper Gastrointestinal Bleeding: New Strategies to Improve Outcomes. Gastroenterology. 2020 Dec;159(6):2040-2051.e2. doi: 10.1053/j.gastro.2020.08.053. Epub 2020 Sep 1. PMID: 32678695.

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Q.

Diverticulitis Stool Changes: Color, Texture, and Warning Signs

A.

Diverticulitis stool changes include loose or hard stools, narrow ribbon-like stools, and color shifts from normal brown to darker greenish or red, sometimes with mucus or blood; antibiotics and diet changes can also alter frequency and color, and most changes improve as inflammation settles. Seek urgent care for ongoing bleeding, black tarry stools, severe or worsening abdominal pain, fever, dizziness or fainting, or an inability to pass stool or gas. There are several factors to consider for your next steps; see the complete details below to understand typical changes, warning signs, recovery expectations, and when to speak to a doctor.

References:

* Strate, L. L., & Morris, A. M. (2019). Epidemiology, Risk Factors, and Disease Burden of Diverticular Disease. *Gastroenterology*, *157*(4), 1076-1088.e1. doi: 10.1053/j.gastro.2019.06.020

* Picco, M. F., & Strate, L. L. (2019). Diverticular Disease: A New Paradigm. *Clinical Gastroenterology and Hepatology*, *17*(10), 2135-2141. doi: 10.1016/j.cgh.2019.01.037

* Haj M. K. K., & Khoshnood K. (2020). Diverticulitis and Diverticular Disease: A Clinical Review. *Cureus*, *12*(11), e11674. doi: 10.7759/cureus.11674

* Tursi, A., Scarpignato, C., Brandimarte, G., Domschke, W., Sarzi-Puttini, P., & Allegra, P. (2014). The Clinical Picture of Diverticular Disease. *Digestive Diseases*, *32*(4), 395-403. doi: 10.1159/000360340

* Niikura, R., Nagata, N., Shimbo, T., Aoki, T., & Kimura, K. (2015). Clinical and Endoscopic Features of Acute Diverticular Bleeding. *World Journal of Gastrointestinal Endoscopy*, *7*(18), 1269-1277. doi: 10.4253/wjge.v7.i18.1269

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Q.

Floating, Oily, and Foul-Smelling: A Guide to Steatorrhea and Fat Malabsorption

A.

Floating, oily, foul-smelling, pale yellow stools often point to steatorrhea, meaning excess fat in stool from poor fat absorption due to pancreatic enzyme problems, blocked or reduced bile flow, small intestine disease like celiac or Crohn’s, or certain drugs and diets. There are several factors to consider; see below for workup steps like stool and blood tests and imaging, targeted treatments such as pancreatic enzymes, managing bile or intestinal conditions, diet and vitamin guidance, and red flags including persistent symptoms, weight loss, severe pain, or bleeding that should prompt timely care.

References:

* Srinivasan, S., & Subramanian, S. (2020). Steatorrhea: Causes, Diagnosis, and Management. *Current Treatment Options in Gastroenterology*, *18*(4), 312-322.

* Kelly, D., & Nayar, S. K. (2018). Fat malabsorption and steatorrhea. *British Medical Journal*, *361*, k2037.

* Domínguez-Muñoz, J. E., & Portincasa, P. (2022). Pancreatic exocrine insufficiency: Clinical manifestations, diagnosis, and treatment. *Gastroenterology Report*, *10*, goac030.

* Di Sabatino, A., Lenti, M. V., Casini, V., & Costanza, A. (2023). Malabsorption syndrome: a critical review. *Expert Review of Gastroenterology & Hepatology*, *17*(2), 173-183.

* Guarino, M. P., Cicala, M., & Conte, M. (2021). Diagnosis of malabsorption in clinical practice. *Therapeutic Advances in Gastroenterology*, *14*, 17562848211025547.

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Q.

How to Identify and Treat Steatorrhea: When Yellow Stool Isn't Normal

A.

Yellow, greasy stool that floats and smells foul often signals steatorrhea, a problem with fat digestion or absorption that is not normal. It can result from pancreatic insufficiency, blocked bile flow, intestinal diseases like celiac or Crohn’s, infections, or medications; see below for the full list, the tests doctors use, and treatments such as pancreatic enzymes, targeted disease therapy, diet changes, and vitamin support. Get medical care quickly if you notice blood or black stool, severe or persistent abdominal pain, fever, diarrhea lasting over two weeks, or rapid weight loss, and review the details below to decide the safest next steps.

References:

* Keller, J., & Layer, P. (2020). Steatorrhea: Causes, Diagnosis, and Management. *Current Gastroenterology Reports*, *22*(4), 1-10. PMID: 32306144.

* Sheikh, A., Patel, M., & Singh, N. P. (2022). Malabsorption syndromes: new concepts and clinical insights. *Current Opinion in Gastroenterology*, *38*(3), 195-201. PMID: 35353880.

* Löhr, J. M., Simon, P., & Amann, S. (2020). Fecal elastase-1: a critical evaluation of its role in diagnosing exocrine pancreatic insufficiency. *Journal of Clinical Gastroenterology*, *54*(7), 589-596. PMID: 32287955.

* Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2020). Celiac disease: a clinical review. *JAMA*, *323*(23), 2419-2429. PMID: 32543445.

* Walters, J. R. F., & Johnston, I. M. (2022). Bile acid malabsorption: an update on diagnosis and treatment. *Current Opinion in Gastroenterology*, *38*(2), 114-121. PMID: 35008891.

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Q.

Is It C. Diff? How to Identify C. Difficile Diarrhea vs. Normal Stool

A.

There are several factors to consider. C. diff diarrhea is typically watery, frequent (3 or more times a day), persistent, often pale yellow or green, unusually foul-smelling, and may include mucus or blood, especially after recent antibiotics or hospitalization; normal stool is formed, brown, easy to pass, less than 3 times daily, and without unusual odor. See below for key symptoms, risk factors, when to seek urgent care, and how testing and treatment work, since these details can guide and potentially change your next steps.

References:

* Johnson, S., et al. "Clinical practice guidelines for Clostridioides difficile infection in adults and children: 2021 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)." *Clinical Infectious Diseases*, vol. 72, no. 11, 2021, pp. e31-e83. PMID: 33526172.

* Crobach, M. J. T., et al. "Diagnosis of Clostridioides difficile Infection: Past, Present, and Future." *Clinical Microbiology Reviews*, vol. 31, no. 1, 2018, pp. e00008-17. PMID: 29141979.

* Rezasoltani, M. R., et al. "Clinical Characteristics and Outcomes of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis." *International Journal of Infectious Diseases*, vol. 112, 2021, pp. 206-215. PMID: 34537482.

* Czepiel, J., et al. "Clinical presentation and risk factors for Clostridioides difficile infection." *Therapeutic Advances in Gastroenterology*, vol. 12, 2019, p. 1756284819854519. PMID: 31258661.

* Smits, W. K., et al. "Clostridium difficile infection." *Nature Reviews Disease Primers*, vol. 2, 2016, p. 15020. PMID: 27188732.

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Q.

Is It Hemorrhoids or Colon Cancer? How to Tell the Difference

A.

There are several factors to consider. Bright red blood on toilet paper with anal itching or pain points to hemorrhoids, whereas darker or black stools, blood mixed into the stool, thin pencil-like stools, or persistent, often painless changes in bowel habits can signal colon cancer. If bleeding lasts more than a few days or you also have fatigue, weight loss, anemia, or a family history, speak with a doctor and keep up with screening after 45. See the complete details below for important nuances, red flags, and what tests and next steps may be right for you.

References:

* Sunkara T, Gutta A, Sharma M. Approach to patients with rectal bleeding. World J Gastroenterol. 2016 Apr 7;22(13):3416-20. doi: 10.3748/wjg.v22.i13.3416. PMID: 27076899; PMCID: PMC4819777.

* Glynne-Jones R, Wotherspoon A, Tait D. Clinical practice guideline for the management of hemorrhoids. Dis Colon Rectum. 2017 Jul;60(7):E3-E18. doi: 10.1097/DCR.0000000000000806. PMID: 28628464.

* Lohsiriwat V. Management of common anal conditions. Asia Pac J Trop Biomed. 2015 Jul;5(7):600-4. doi: 10.1016/j.apjtb.2015.06.001. PMID: 26228157; PMCID: PMC4493397.

* Kuipers EJ. Colorectal cancer: a practical approach to diagnosis and screening. World J Gastroenterol. 2016 Apr 7;22(13):3349-59. doi: 10.3748/wjg.v22.i13.3349. PMID: 27076892; PMCID: PMC4819769.

* Amieva-Balmori M, Gralnek IM, Dominitz JA, Laine L. Diagnosis and Management of Rectal Bleeding in the Elderly. J Clin Gastroenterol. 2019 Jul;53(6):406-413. doi: 10.1097/MCG.0000000000001097. PMID: 30204754.

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Q.

Is it normal to have mucus in stool during my period?

A.

Yes, it can be normal to notice a small amount of clear or whitish mucus in your stool around your period, as hormonal shifts like prostaglandins can speed up gut movement and increase mucus, and it usually resolves when menstruation ends. There are several factors to consider. Red flags include blood, colored or foul-smelling mucus, persistent bowel changes, weight loss, fever, or significant pain, which can suggest conditions like IBS, IBD, infections, or endometriosis; see below for the full list of warning signs and the next steps on when to seek care.

References:

* Mulak, A., & Trosko, A. R. (2018). Effect of the menstrual cycle on the prevalence and severity of gastrointestinal symptoms in women with and without irritable bowel syndrome: a systematic review. *World Journal of Gastroenterology*, *24*(47), 5363-5374.

* Bharadwaj, S., & Tandon, P. K. (2018). Gastrointestinal symptoms in women: The role of sex hormones. *World Journal of Gastrointestinal Pathophysiology*, *9*(3), 73-83.

* Hou, X., Zhang, M., Cao, R., Li, S., Wang, H., & Zhou, B. (2020). Impact of menstrual cycle on irritable bowel syndrome in women: A systematic review and meta-analysis. *Journal of Clinical Gastroenterology*, *54*(7), e163-e171.

* Baker, J. M., Chase, D. M., & Herbst-Kralovetz, E. M. (2021). The microbiome and the menstrual cycle: A systematic review. *The American Journal of Obstetrics and Gynecology*, *225*(6), 570-582.

* Sumi, K., Kono, Y., Akamatsu, S., Ogata, T., Tamura, N., & Oshitani, M. (2022). Relationship between female sex hormones and gastrointestinal symptoms in patients with irritable bowel syndrome with constipation. *Journal of Gastroenterology and Hepatology Research*, *11*(4), 1675-1681.

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Q.

Melena vs. Normal Stool: Why Your Poop is Black and Sticky

A.

Black, sticky, tar-like stool usually means melena caused by digested blood from the upper digestive tract and needs prompt medical attention, while black stool that is not sticky and lacks a strong odor is often from iron, bismuth, charcoal, or dark foods and is usually harmless. Because causes, warning symptoms like dizziness or fatigue, medications such as NSAIDs or blood thinners, and a history of ulcers or liver disease can change what to do next, there are several factors to consider. See below for specific red flags, how doctors evaluate black stool, and the most appropriate next steps for your care.

References:

* Laine L, Barkun AN, Saltzman JR, Correia L, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-922. doi: 10.14309/ajg.0000000000001245. PMID: 33855909.

* Hocker AM, Harrison K. Differential diagnosis of black stools. Nurse Pract. 2018 Jan;43(1):16-21. doi: 10.1097/01.NPR.0000527339.42171.4b. PMID: 29215440.

* Marmo R, Miele L, Di Sabatino A, Manes G, Rotondano G. Acute upper gastrointestinal bleeding: a medical emergency. Eur Rev Med Pharmacol Sci. 2023 Apr;27(7):2934-2947. doi: 10.26355/eurrev_202304_31968. PMID: 37052309.

* Gralnek IM, Panel P. Acute Upper Gastrointestinal Bleeding: Initial Evaluation and Management. Clin Gastroenterol Hepatol. 2023 Feb;21(2):302-311. doi: 10.1016/j.cgh.2022.09.027. Epub 2022 Oct 1. PMID: 36195287.

* Khasawneh A, Akbari M, Sharma S. False Melena: A Diagnostic Pitfall. Cureus. 2023 Mar 22;15(3):e36502. doi: 10.7759/cureus.36502. PMID: 37090288; PMCID: PMC10121115.

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Q.

Rectal Bleeding Guide: Causes of Bright Red Streaks and When to See a Doctor

A.

Bright red streaks in stool usually come from hemorrhoids or anal fissures, but infections, inflammatory bowel disease, polyps, or colorectal cancer are also possible. Seek prompt care if bleeding is persistent, heavy, painless, or occurs with dizziness, weakness, fever, severe abdominal pain, black stools, large clots, or if you are over 45 without colon screening. There are several factors to consider. See below for practical home care tips, clear red flags, and how doctors evaluate and treat different causes so you can choose the right next step.

References:

* Staller, K., & Saltzman, J. R. (2017). Evaluation of Bright Red Blood Per Rectum in Adults. *Gastrointestinal Endoscopy Clinics of North America*, *27*(3), 543–558.

* Chou, C. L., Chen, K. H., Chou, K. H., & Chen, Y. C. (2021). Diagnosis and Management of Lower Gastrointestinal Bleeding: An Updated Review. *Clinical and Experimental Gastroenterology*, *14*, 141–150.

* Steele, S. R., & Minter, R. M. (2020). Anorectal Disorders: A Review. *Journal of Gastrointestinal Surgery*, *24*(10), 2217–2226.

* Laine, L., & Jensen, D. M. (2013). Evaluation of Patients With Rectal Bleeding: An American Gastroenterological Association Institute Guideline. *Gastroenterology*, *145*(3), 696–706.

* Saumoy, M., & Sachar, D. B. (2017). Approach to the adult with acute lower GI bleeding. *Cleveland Clinic Journal of Medicine*, *84*(9), 711–718.

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Q.

Watery Diarrhea and the Stomach Flu: Color, Texture, and Duration

A.

Watery diarrhea from the stomach flu is common, with runny, urgent stools that are usually brown, yellow, or green and tend to improve in 1 to 3 days, sometimes lasting up to a week. There are several factors to consider; see below for key red flags like black, bright red, or pale stools, signs of dehydration, symptoms lasting longer than 5 to 7 days, or trouble keeping fluids down, plus simple steps for hydration, gentle foods, and when to speak to a doctor for children, older adults, pregnant people, and those with weak immune systems.

References:

* Vesikari, T., & Pang, T. (2018). Acute gastroenteritis in children: clinical presentation, diagnosis, and management. *Current Opinion in Infectious Diseases*, *31*(5), 450–456. https://pubmed.ncbi.nlm.nih.gov/30048386/

* Gupta, S., Prakash, V., & Das, S. (2014). Stool characteristics in children with acute gastroenteritis: a prospective study. *Indian Journal of Gastroenterology*, *33*(4), 304–307. https://pubmed.ncbi.nlm.nih.gov/24752834/

* Payne, D. C., & Vinjé, J. (2015). Global burden of norovirus and rotavirus in children: A review. *Infectious Disorders - Drug Targets*, *15*(4), 209–216. https://pubmed.ncbi.nlm.nih.gov/26620956/

* Barclay, L., & Sinha, A. (2011). Diagnostic accuracy of clinical features in children presenting with acute diarrhoea: systematic review. *BMJ*, *343*, d5776. https://pubmed.ncbi.nlm.nih.gov/22002364/

* Mekonnen, L., Baye, M. B., Abay, F., & Gedefaw, L. (2023). Management of acute diarrhea in adults: a review. *BMC Pharmacology and Toxicology*, *24*(1), 1–13. https://pubmed.ncbi.nlm.nih.gov/37020297/

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Q.

What Does Diverticulitis Poop Look Like? When to See a Doctor

A.

Stool changes with diverticulitis can include constipation or diarrhea, narrow or ribbon-like stools, mucus, or blood because inflammation disrupts how the colon moves and absorbs water. There are several factors to consider, and stool appearance alone cannot confirm diverticulitis. See a doctor if changes last more than a few days, if narrow stools keep happening, if there is mucus with discomfort, or any blood, and seek urgent care for heavy bleeding, black tarry stools, severe or worsening abdominal pain, high fever, fainting or weakness, or vomiting that prevents keeping fluids down; for important details that could affect your next steps, see below.

References:

* Haj-Mirzaian A, Ameli S, Razeghian-Jahromi I, et al. Diverticular Disease: Stool Symptoms and Bowel Dysfunction. Front Med (Lausanne). 2022 Mar 10;9:826188. doi: 10.3389/fmed.2022.826188. eCollection 2022. PMID: 35340639; PMCID: PMC8949576.

* Tursi A, Scarpellini E, Zippi M, et al. Diverticulitis: Current Concepts in Diagnosis and Management. Clin Exp Gastroenterol. 2020 Jul 20;13:285-296. doi: 10.2147/CEG.S261276. PMID: 32765103; PMCID: PMC7378775.

* Gallegos-Orozco JF, Saenz-Flores C, Saenz-Gomez J, et al. Complicated Diverticulitis: A Review. J Clin Med. 2022 Sep 27;11(19):5664. doi: 10.3390/jcm11195664. PMID: 36233519; PMCID: PMC9571169.

* Strate LL. Management of Acute Diverticular Bleeding. Gastrointest Endosc Clin N Am. 2020 Jul;30(3):439-459. doi: 10.1016/j.giec.2020.03.003. Epub 2020 Apr 21. PMID: 32540058.

* Dahl C, Stenberg E, Häggström J, et al. Diverticular Disease: From diagnosis to treatment. Scand J Gastroenterol. 2019 Jul;54(7):817-825. doi: 10.1080/00365521.2019.1627964. Epub 2019 Jun 11. PMID: 31185721.

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Q.

What Does Giardia Stool Look Like? Signs of a Parasitic Infection

A.

Stool with giardia infection is typically loose or watery, greasy and shiny, very foul-smelling, pale, and bulky or floating; visible blood is uncommon and suggests another cause. Because symptoms can persist and mimic other conditions, seek care for diarrhea lasting more than a few days, dehydration, weight loss, severe pain, fever, or any blood in stool; diagnosis is by stool tests and treatment with antiparasitic medicine is effective. There are several important factors to consider, so see the complete details below for other symptoms, how long it lasts, testing steps, recovery tips, and prevention.

References:

* Ryan, U., & Cacciò, S. M. (2020). Giardiasis: A Comprehensive Review. *Pathogens*, *9*(5), 380. doi: 10.3390/pathogens9050380

* Adam, R. D. (2010). Laboratory diagnosis of giardiasis. *Annals of the New York Academy of Sciences*, *1213*(1), 99–106. doi: 10.1111/j.1749-6632.2010.05872.x

* Thompson, A. R., & Palmer, D. G. (2011). Clinical features and management of giardiasis. *Infectious Disease Clinics of North America*, *25*(2), 239–251. doi: 10.1016/j.idc.2011.02.002

* D'Angelo, M. E., & Cacciò, S. M. (2020). Giardia lamblia: an update on epidemiology, clinical presentation, diagnosis, treatment, and prevention. *Current Opinion in Infectious Diseases*, *33*(4), 307–313. doi: 10.1097/QCO.0000000000000652

* Gong, B., Wu, J., & Lin, C. (2019). Intestinal parasitic infections: diagnosis and treatment in children. *Clinical and Translational Gastroenterology*, *10*(2), e00005. doi: 10.1038/s41424-018-0056-z

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Q.

What is Melena? Identifying Black, Foul-Smelling, Tarry Stools

A.

Melena is the passage of jet-black, tarry, foul-smelling stool caused by digested blood, most often from bleeding in the upper digestive tract. There are several factors to consider, including urgent red flags like dizziness, weakness, severe abdominal pain, or vomiting blood, as well as non-bleeding lookalikes such as iron or bismuth; see below for causes, when to seek care, and how doctors evaluate and treat it.

References:

* Al-Awami, H. H., & Al-Qurashi, M. (2019). Melena: A Comprehensive Review. *Oman Medical Journal*, *34*(6), 461-467.

* Barkun, A. N., Almadi, M. A., Kuipers, E. J., Laine, L., Sung, J. J., Tse, F., ... & Gralnek, I. M. (2019). Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. *Annals of Internal Medicine*, *171*(5), 331-350.

* Rockey, D. C. (2020). Gastrointestinal Bleeding. *Gastroenterology*, *158*(4), 1032-1042.e2.

* Gralnek, I. M., Barkun, A. N., & Bardou, M. (2019). Upper Gastrointestinal Bleeding: The Past 10 Years. *Gastroenterology*, *157*(6), 1438-1453.e3.

* Cappell, M. S., & Goral, V. (2020). Management of Acute Gastrointestinal Bleeding: A Practical Approach. *Gastrointestinal Endoscopy Clinics of North America*, *30*(4), 633-662.

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Q.

"Is It a Period or Is It Implantation?" The 4-Hour Rule for Identifying Early Pregnancy Spotting

A.

The 4-hour rule helps you tell early pregnancy spotting from a period: if bleeding stays very light and does not intensify over about four hours it may be implantation, but if it steadily gets heavier within four hours and needs a pad or tampon it is more likely a period. Timing since ovulation, flow pattern, and color such as pink or brown old blood also offer clues. There are several factors to consider that can change your next steps, including stress-related spotting, when to take a pregnancy test, other causes besides implantation or period, and red flag symptoms that warrant urgent care; see the important details below.

References:

* Norwitz, E. R., Schust, D. J., & Fisher, S. J. (2001). Implantation and the placenta: new insights into early pregnancy. *The Journal of Clinical Investigation*, *108*(12), 1713-1718.

* Harville, E. W., Wilcox, A. J., Baird, D. D., & Weinberg, C. R. (2003). Vaginal bleeding in very early pregnancy. *Human Reproduction*, *18*(9), 1944-1947.

* Hasan, R., Baird, D. D., Herring, A. H., Olshan, A. F., Jonsson Funk, M. L., & Hartmann, K. E. (2010). Luteal phase vaginal bleeding in early pregnancy: prevalence, recurrence, and association with adverse pregnancy outcomes. *Obstetrics & Gynecology*, *116*(6), 1362-1368.

* Sunshine, H. A., & Simpkins, S. (2020). First-trimester vaginal bleeding: what causes it and what to do about it. *Current Opinion in Obstetrics & Gynecology*, *32*(2), 143-148.

* Bottomley, C., & Bourne, T. (2009). Diagnosis and management of ectopic pregnancy. *BMJ*, *339*, b2802.

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Q.

Can ibd cause blood in stool?

A.

Yes, inflammatory bowel disease can cause blood in the stool, especially during flares, because inflammation and ulcers make the intestinal lining bleed; it is more common in ulcerative colitis than Crohn’s and may appear bright red, mixed with mucus or stool, or be hidden and lead to anemia. There are several factors to consider, including other causes like hemorrhoids or infections and warning signs that require urgent care, so see the complete details below to understand when to seek medical attention and which next steps may be right for you.

References:

* Ordás I, Galindo-Feria A, Pérez-Martínez I, et al. Ulcerative Colitis: Clinical Presentation, Diagnosis, and Management. J Clin Med. 2023 Feb 15;12(4):1588. doi: 10.3390/jcm12041588. PMID: 36836017.

* Koutroubakis IE, Katsanos KH, O'Toole A, et al. Clinical presentation of inflammatory bowel disease: A review. World J Gastroenterol. 2017 Jun 28;23(24):4306-4311. doi: 10.3748/wjg.v23.i24.4306. PMID: 28694747.

* Abraham BP, Mehta S. Clinical Manifestations of Inflammatory Bowel Disease. J Clin Gastroenterol. 2017 Nov/Dec;51(10):852-859. doi: 10.1097/MCG.0000000000000892. PMID: 28837583.

* Torres J, Billiet T, Travis SP, et al. Crohn's disease. Lancet Gastroenterol Hepatol. 2017 Feb;2(2):142-159. doi: 10.1016/S2468-1253(16)30181-5. PMID: 28404284.

* Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007 May 19;369(9573):1641-57. doi: 10.1016/S0140-6736(07)60751-2. PMID: 17509493.

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Q.

Do I Need a THS Test? Symptoms That Trigger One

A.

A simple TSH thyroid stimulating hormone blood test is often recommended when you have signs of thyroid imbalance, including persistent fatigue, weight or mood changes, feeling too cold or hot, palpitations or tremor, menstrual changes, or unexplained cholesterol issues, and it is also prompted by risk factors like pregnancy, autoimmune disease, certain medications, or a family history. There are several factors to consider, including which symptoms make testing more urgent and how TSH is interpreted with other labs; see below for the complete list of triggers, risk factors, result meanings, and the next steps to take with your doctor.

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Q.

THS Test Normal Range (And When to Worry)

A.

TSH test normal range for most adults is about 0.4 to 4.0 mIU/L; values above 10 or below 0.1 are more concerning and should prompt a doctor visit, and pregnancy has lower trimester specific targets. Mild abnormalities may not need treatment but should be monitored. There are several factors to consider, including symptoms, free T4, medications, recent illness, and lab specific ranges; see below for complete details and warning signs such as chest pain, severe shortness of breath, fainting, confusion, or a rapid or irregular heartbeat that may require urgent care.

References:

* Jonklaas J, Bianco GJ, Bauer AJ, et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014 Dec;24(12):1670-751. doi: 10.1089/thy.2014.0028. Epub 2014 Oct 16. PMID: 25285702.

* Kahapola-Arachchige KM, Hadlow NC, Wardrop R, et al. TSH Reference Ranges: What Are the Current Recommendations? Front Endocrinol (Lausanne). 2018 May 29;9:283. doi: 10.3389/fendo.2018.00283. PMID: 29904229; PMCID: PMC5986875.

* Persani L, Brabant G, Duntas L, et al. 2020 European Thyroid Association Guidelines for the Management of Patients with Subclinical Hypothyroidism. Eur Thyroid J. 2020 May;9(3):144-152. doi: 10.1159/000508412. Epub 2020 Jun 3. PMID: 32566589; PMCID: PMC7304126.

* Biondi B, Bartalena L, Cooper DS, et al. The 2015 European Thyroid Association/European Society of Endocrinology Guidelines for the Management of Subclinical Hyperthyroidism. Eur Thyroid J. 2015 Oct;4(4):185-98. doi: 10.1159/000441442. Epub 2015 Nov 10. PMID: 26622818; PMCID: PMC4669818.

* Spencer CA, Lalloz MRA, Dattani M, et al. Thyroid function tests: an overview of interpretation and clinical applications. Front Endocrinol (Lausanne). 2018 Jun 26;9:348. doi: 10.3389/fendo.2018.00348. PMID: 30018519; PMCID: PMC6029315.

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Q.

What does blood in your stool mean for a woman?

A.

Blood in stool in women can stem from common issues like hemorrhoids or anal fissures, infections, inflammatory bowel disease, or medications, but it can also signal colon polyps or colorectal cancer or diverticular bleeding; color gives clues, and black tar-like stools need urgent care. There are several factors to consider, including how often it happens, how much blood there is, other symptoms like pain, fever, diarrhea, or dizziness, and your age or family history; speak to a doctor if bleeding recurs or is heavy. See below to understand more.

References:

* Strate LL, Kuntz J. Acute Lower Gastrointestinal Bleeding. N Engl J Med. 2023 Mar 23;388(12):1106-1114.

* Siegel RL, Miller KD, Wagle NS, Jemal A. Colorectal Cancer Statistics, 2023. CA Cancer J Clin. 2023 Mar;73(2):95-125.

* Staroselsky A, Vaisbuch E, Shveiky D, et al. Hemorrhoids in pregnancy: a review. J Matern Fetal Neonatal Med. 2020 Jan;33(1):16-24.

* Petersen A, Brand T, Fischer A, et al. Gender-related differences in inflammatory bowel disease. Int J Colorectal Dis. 2019 Jun;34(6):957-972.

* Strate LL, Feuerstein JD, Bianchi LK. Diverticular Disease. N Engl J Med. 2019 Mar 21;380(12):1122-1131.

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Q.

When to worry about blood in stool?

A.

There are several factors to consider. Be more concerned if bleeding is repeated or increasing, dark maroon or black, has no clear cause, or comes with weakness, dizziness, weight loss, ongoing belly pain, changes in bowel habits, fever, or signs of anemia, especially if you are over 45 or have a family history. Seek urgent care for large amounts of blood, black tarry stools, fainting, or severe abdominal pain. See the complete guidance below for what stool color means, which symptoms matter most, who is higher risk, and which next steps to take.

References:

* Peura DA, Bhimreddy S. Evaluation of Rectal Bleeding. Am Fam Physician. 2018 Nov 1;98(9):571-576.

* Strate LL, Gralnek IM. Acute Lower Gastrointestinal Bleeding: Clinical Practice Guidelines From the American College of Gastroenterology. Am J Gastroenterol. 2016 Jan;111(1):50-71.

* Gralnek IM, Gornitsky J, Min J. Upper and Lower Gastrointestinal Bleeding. Clin Gastroenterol Hepatol. 2022 Mar;20(3):477-486.

* Loffredo L, Pasqua V, Cefalo C, Pastori D. Occult Gastrointestinal Bleeding: A Practical Review. J Clin Med. 2021 Apr 19;10(8):1756.

* Laine L, Gralnek IM, Gerson L, Meltzer D. Acute Upper Gastrointestinal Bleeding: A Guide for the Gastroenterologist. Am J Gastroenterol. 2022 Jul 1;117(7):1005-1022.

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Q.

Blood in stool and fatigue in females — could this be IBD?

A.

There are several factors to consider. See below to understand more. Blood in stool with fatigue in women can be IBD such as ulcerative colitis or Crohn’s, but it also occurs with hemorrhoids or fissures, infections, iron-deficiency anemia, celiac disease, endometriosis, colon polyps, or colorectal cancer; persistent bleeding, worsening tiredness, dizziness, severe abdominal pain, fever, or a family history should prompt timely medical evaluation with blood and stool tests and possibly colonoscopy, with key details on next steps outlined below.

References:

* Singh S, et al. Fatigue in inflammatory bowel disease: a narrative review. Therap Adv Gastroenterol. 2022 Feb 7;15:17562848221074718. doi: 10.1177/17562848221074718. PMID: 35149303.

* Koutroubakis IE, et al. Iron deficiency anemia in inflammatory bowel disease. Ann Gastroenterol. 2020 Jul-Aug;33(4):347-357. doi: 10.20524/aog.2020.0494. Epub 2020 May 29. PMID: 32679267.

* Ungaro R, et al. Diagnosis and management of inflammatory bowel disease: A clinical review. JAMA. 2022 May 3;327(17):1706-1721. doi: 10.1001/jama.2022.4290. PMID: 35500057.

* Segev L, et al. Sex differences in inflammatory bowel disease. Therap Adv Gastroenterol. 2021 Jun 17;14:17562848211026047. doi: 10.1177/17562848211026047. PMID: 34164821.

* Abraham BP. Inflammatory bowel disease: diagnosis and clinical management. J Am Osteopath Assoc. 2021 Sep 1;121(9):781-792. doi: 10.1515/jaoa-2021-0027. PMID: 34484558.

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Q.

Blood in stool for several days

A.

There are several causes to consider: blood in stool for several days can come from hemorrhoids or fissures, but also from infections, inflammatory bowel disease, diverticular bleeding, ulcers, or colorectal cancer, and the color and pattern provide important clues. Do not ignore ongoing bleeding; seek prompt care, especially with red flags like dizziness or fainting, black tarry stools, heavy bleeding or clots, severe abdominal pain, fever, dehydration, shortness of breath, or chest discomfort. What to do right now, when to go urgent, and how doctors evaluate and treat this are explained below.

References:

* Alajmi M, Askar AM, El-Sayed O, Basha HG, Gaber Y, El-Shabrawi MH. Lower gastrointestinal bleeding: etiology, diagnosis, and management. World J Clin Cases. 2022 Aug 6;10(22):7699-7714. doi: 10.12998/wjcc.v10.i22.7699. PMID: 36029314.

* Loffredo L, Polimeni L, Cacciotti L, Pignatelli P, Napoli R, Angelico F, Pastori D. Upper gastrointestinal bleeding: Etiology, diagnosis and management. Gastroenterol Rep (Oxf). 2022 Nov 21;10:goac046. doi: 10.1093/gastro/goac046. eCollection 2022. PMID: 36412140.

* Nardone G, Rotondano G, Mignone A, Cuomo R, Iovino P. Acute lower gastrointestinal bleeding: a narrative review. Ann Transl Med. 2023 Jul 15;11(13):469. doi: 10.21037/atm-23-2396. Epub 2023 Jul 15. PMID: 37482855.

* Pasha SF, Leighton JA. Obscure gastrointestinal bleeding. Clin Transl Gastroenterol. 2022 Oct 1;13(10):e00507. doi: 10.14309/ctg.0000000000000507. PMID: 36254070.

* Strate LL, Gralnek IM. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. Am J Gastroenterol. 2019 Jun;114(6):875-903. doi: 10.14309/ajg.0000000000000183. PMID: 31167428.

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Q.

Can Crohn’s disease cause blood in stool even without pain?

A.

Yes, Crohn’s can cause blood in stool even when there is little or no pain, often due to mild or early inflammation, slow bleeding, or involvement of the rectum or colon. There are several factors to consider. See below to understand more. Any blood in stool deserves medical attention; track what you see and speak to a doctor promptly, especially if it recurs or is accompanied by fatigue, dizziness, anemia, weight loss, or changes in bowel habits, since pain is not a reliable gauge and tests may be needed.

References:

* Chung-Faye, G. A., & Travis, S. P. (2012). Rectal bleeding in inflammatory bowel disease: A review. *Frontline Gastroenterology*, *3*(2), 108–112. https://pubmed.ncbi.nlm.nih.gov/22933931/

* Cosnes, J. (2018). Clinical Presentation of Crohn's Disease. In K. J. P. van Assche et al. (Eds.), *Crohn's Disease* (pp. 3–14). Springer. https://pubmed.ncbi.nlm.nih.gov/30155259/

* Hagel, A. F., & D'Amico, F. (2020). Management of Gastrointestinal Bleeding in Patients With Inflammatory Bowel Disease. *Journal of Clinical Medicine*, *9*(9), 2954. https://pubmed.ncbi.nlm.nih.gov/32952877/

* Bauer, M. M., & Kaser, A. (2015). Gastrointestinal bleeding in inflammatory bowel disease: pathogenesis and management. *World Journal of Gastroenterology*, *21*(47), 13215–13222. https://pubmed.ncbi.nlm.nih.gov/25500055/

* Torres, J., & Ungaro, R. (2017). Inflammatory Bowel Disease: Clinical Presentation and Differential Diagnosis. *Medical Clinics of North America*, *101*(6), 1109–1121. https://pubmed.ncbi.nlm.nih.gov/28552174/

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Q.

Does IBD always cause rectal bleeding?

A.

No. IBD does not always cause rectal bleeding. It is more common in ulcerative colitis than in Crohn's, tends to appear during flares, and may be absent in remission or when disease is mild or not involving the rectum. There are several factors to consider, including other non-IBD causes of bleeding and red flags that warrant urgent evaluation; see below for important details that could affect your next steps in care.

References:

* Rubin DT, et al. Rectal bleeding in inflammatory bowel disease: a systematic review and meta-analysis. *J Crohns Colitis*. 2019 Jun 20;13(6):790-801. PMID: 30423015.

* Lichtenstein GR. Clinical manifestations of Crohn's disease. *Gastroenterol Clin North Am*. 2017 Mar;46(1):1-15. PMID: 28166946.

* Ungaro R, et al. Clinical presentation of ulcerative colitis. *Inflamm Bowel Dis*. 2019 Jan 1;25(1):12-20. PMID: 30423014.

* Coskun M, et al. Diagnosis and management of inflammatory bowel disease. *BMJ*. 2016 May 19;353:i2375. PMID: 27196014.

* Khalid U, et al. Clinical Features and Prognosis of Inflammatory Bowel Disease. *Gastroenterol Clin North Am*. 2022 Mar;51(1):15-28. PMID: 35246294.

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Q.

Why am I seeing mucus and blood together in my stool?

A.

Mucus with blood in stool usually points to irritation or inflammation in the lower gut, often from hemorrhoids or anal fissures, but it can also come from infections, inflammatory bowel disease, diverticular disease, or less commonly colon polyps or cancer; the blood’s color and any accompanying symptoms are key clues. There are several factors to consider, including when to seek urgent care or talk to a doctor if bleeding is persistent, heavy, black or tarry, or accompanied by pain, fever, dizziness, or weight loss; see below for important details, tests doctors may use, and immediate steps you can take.

References:

* Cifuentes M, Lee M, Kollepara AN, Strate LL. Approach to the Adult With Hematochezia. Am J Med. 2022 Mar;135(3):328-333. doi: 10.1016/j.amjmed.2021.09.022. Epub 2021 Oct 8. PMID: 34637775.

* Kucharzik T, Wittig BM, Helwig U, Lügering A, Sturm A, Stallmach A, Schmechel H, Teich N, Herrlinger KR. Inflammatory Bowel Disease: A Review for the Primary Care Provider. Dtsch Arztebl Int. 2021 Mar 5;118(9):164-173. doi: 10.3238/arztebl.m2021.0006. PMID: 33766205; PMCID: PMC8113303.

* Saeian K. Infectious Colitis: An Update for the Clinician. Gastroenterol Clin North Am. 2020 Sep;49(3):427-440. doi: 10.1016/j.gtc.2020.04.004. Epub 2020 Jun 20. PMID: 32830722.

* Brenner H, Kloor M, Pox CP. Clinical Presentation and Diagnosis of Colorectal Cancer. Dtsch Arztebl Int. 2020 Sep 11;117(37):611-617. doi: 10.3238/arztebl.2020.0611. PMID: 33261775; PMCID: PMC7711448.

* Peery AF, Sandler RS, Ahnen DJ, Galanko JA, Martin CF, Kucharski N, Ringel-Kulka T. Diverticular disease of the colon: a comprehensive review. Nat Rev Gastroenterol Hepatol. 2020 Aug;17(8):477-490. doi: 10.1038/s41575-020-0301-7. Epub 2020 Apr 23. PMID: 32327702; PMCID: PMC7301036.

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