Blood in Stool (Hematochezia, Melena): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate hematochezia (appearance of fresh blood in the stool) or melena (tarry stools):

Leading symptoms

  • Hematochezia (blood stool; rectal bleeding); appearance of fresh blood in stool.
    • Mainly bleeding from the middle and lower gastrointestinal tract (gastrointestinal tract) (localization: transverse colon (transverse colon), descending colon (descending colon), colonic sigmoid (sigmoid), rectum (rectum or rectal)).
  • Melena (tarry stools; pitch stools); usually associated with bleeding from the upper gastrointestinal tract (gastrointestinal tract); results from bacterial breakdown of blood in the lower intestinal tract (localization: stomach and duodenum (duodenum); less commonly, small intestine and ascending colon (ascending colon/colon))
    • The interval between the onset of bleeding and the appearance of tarry stools is 8-10 h
    • Occurrence from a daily blood loss of 50-100 ml.

Cave (Attention!)

  • If hemorrhoids are discovered, this is not always the only underlying cause!

Warning signs (red flags)

  • Medical history:
    • Younger patients → think: inflammatory bowel disease (IBD), polyps.
    • Older patients → think of: Diverticular and polyp hemorrhage, carcinoma, CED, proctitis (rectal inflammation).
    • Colonoscopy with polyectomy (colonoscopy with removal of polyps)/adenomectomy (removal of adenomas).
    • Anemia (anemia) → think of: Colon carcinoma (cancer of the large intestine).
    • Rectal cancer (cancer of the rectum)
  • Syncope (momentary loss of consciousness).
  • Altered stool behavior or change in stool consistency (alternation of constipation/constipation and diarrhea/diarrhea) + unwanted weight loss → think of: Colon carcinoma (colon cancer).
  • Heavy and painless bleeding + elderly → think of: Diverticulosis (change in the colon in the form of small protrusions of the intestinal wall).
  • Child with blood in stool where no cause can be found → think of: Child abuse
  • Peranal (“through the anus“) discharge of large amounts of blood or coagula (clotted blood).
  • Continuous medication: see below drug side effects: “bleeding due to medication”.