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.
- 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”.