The presence of blood in the child’s stool can be worrisome for parents. However, it may not always be a cause for concern. In fact, it is quite commonly observed by healthcare practitioners (1).
There are numerous causes of blood-streaked stool in children and adolescents. Some are not so complicated and require little or no treatment. However, some causes may be more serious and require immediate medical attention.
Keep reading this MomJunction post to know about the possible causes of bloody stools in children, diagnosis, and home remedies that may help.
Is It Really Blood In Your Child’s Stool?
Often, the consumption of certain foods or medicines may give the child’s stool a bloody appearance or test positive for the presence of blood (1). Such foods include:
- Flavored gelatin
- Kool-Aid or similar beverages
- Red licorice
- Iron supplements
- Antibiotics (ampicillin)
- Bismuth preparations (Pepto-Bismol)
[ Read: Sepsis In Children ]
Signs Of Bloody Stool In Children
Depending on the cause and source, the appearance of blood (color and intensity) in the stool may vary. It can range from bright red to tarry black (1).
- The presence of bright red blood in the stool is known as hematochezia. This may be because of the bleeding in the colon or rectum (lower gastrointestinal tract) (1).
- Maroon-colored stool may indicate bleeding in the small intestine (2).
- The appearance of dark tarry stools, also known as melena, may indicate bleeding in the upper gastrointestinal tract or esophagus, stomach, and duodenum (1, 2).
[ Read: Diarrhea In Children ]
Causes of Bloody Stool in Children
Age is an important factor in identifying the cause of rectal bleeding in children and adolescents (1). Some of the common causes in children (2-12 years old) and adolescents (12-18 years old) include the following (3).
1. Anal fissure:
It is a tear or a break in the skin of the anus. One of the most common causes of rectal bleeding in children, this usually occurs due to hard stool or constipation (4). Sometimes, cases of explosive diarrhea may also result in such tears (5).
You may notice streaks of blood in your child’s stool or on the toilet paper. These fissures can also cause pain and discomfort during a bowel movement (4).
2. Juvenile polyp:
Juvenile polyps are the most common types of intestinal polyps that occur in children aged between three and ten years. They are characterized by bleeding and abdominal pain (6).
3. Infectious colitis (infection):
Bacterial, viral, or parasitic infection can cause bloody stool (usually with diarrhea) in any age group. Common pathogens include Salmonella, Shigella, Campylobacter, Yersinia enterocolitica, Clostridium difficile, and Escherichia coli (3). Entamoeba histolytica is a common water-borne parasite that can cause bloody diarrhea.
4. Inflammatory bowel disease (IBD):
Inflammatory bowel disease consists of two conditions.
- Crohn’s disease: It can occur in any part of the gastrointestinal (GI) tract – from the mouth to the anus.
- Ulcerative colitis: It occurs in the large intestine (colon) or rectum.
It is characterized by chronic inflammation of the GI tract. Some of the common symptoms may include abdominal pain, rectal bleeding, weight loss, fatigue, and diarrhea (7).
Most cases are diagnosed after 15 years of age (7).
5. Solitary rectal ulcer:
Although rare in children, it is characterized by bloody stools, constipation, mucus discharge, abdominal pain, and prolonged straining. It is often misdiagnosed or may remain undiagnosed (8).
6. Intestinal obstruction (intussusception):
Intussusception is a common cause of intestinal obstruction in children up to three years of age. It can also occur in older children and teenagers. The condition is characterized by severe abdominal pain, bloody stools, red currant jelly-like stools, fever, extreme fatigue, vomiting, diarrhea, and a swollen abdomen (9).
7. Henoch-Schonlein purpura:
This syndrome, also known as Ig A vasculitis, affects children in the age group of 3 to 15 years. It is characterized by purple spots on the skin, joint pain, gastrointestinal problems (sometimes bloody stools), and kidney disorder (10).
8. Hemolytic-uremic syndrome:
Most common in children, this condition generally occurs after E. Coli infection in the GI tract. Children may experience vomiting, diarrhea, fever, lethargy, bloody stools, and fatigue (11).
9. Hemorrhoids (Piles):
Hemorrhoids are veins around the anus that become swollen because of extensive stretching under pressure. Piles can occur due to prolonged straining during a bowel movement, chronic constipation, or diarrhea. Symptoms in children may include pain and swelling around the anus, itching, or bright red blood in the stool (12).
10. Upper gastrointestinal hemorrhage:
In younger children, upper gastrointestinal bleeding can sometimes result in the passage of bright red blood in the stool (hematochezia). This may be due to relatively faster intestinal transit time as compared to that of adults (3).
Diarrhea And Blood In Child’s Stool
- Inflammatory bowel disease (ulcerative colitis & Crohn’s disease)
- Intestinal infection caused by bacteria, virus, or parasite
- Juvenile polyp (not so common)
- Intussusception (not so common)
Mucus and Blood In Child’s Stool
- Inflammatory bowel disease (ulcerative colitis & Crohn’s disease)
- Solitary rectal ulcer
- Infection (Clostridium difficile or amoebic infection)
Diagnosing the Cause of Blood In Stool
Healthcare practitioners may consider the medical history, age of the child, and physical examination to narrow down the causes of rectal bleeding. Physical examination of anus and perineum may be performed to identify any signs of fissures or fistulas (3).
- Colonoscopy, the most preferred diagnostic technique for rectal bleeding.
- Stool evaluation and culture (e.g., Wright stain)
- Complete blood count
- Ultrasound of the abdomen
- CT scan or MRI
- Abdominal radiography or X-ray
If necessary, the doctor will suggest a treatment plan based on the underlying cause. Along with that, you could try a few home remedies to minimize the risk of bloody stools. You may use these for mild cases of bloody stool.
Home Remedies to Relieve Symptoms
- Warm sitz baths: These baths involve sitting in warm, shallow waters to relieve symptoms of fissures, hemorrhoids, and other conditions. Soaking of the bottom or perineum area (around the anus) can soothe pain, itching, irritation, etc. Doctors may sometimes recommend adding medications or soothing agents such as salt, baking soda, or vinegar for better relief.
- High-fiber diet: To relieve constipation symptoms in your child, healthcare practitioners may recommend switching to a high-fiber diet. Including whole fruits (banana, pears, berries, etc.), vegetables (broccoli, green peas, etc.), and whole grains (oatmeal, whole-grain bread, or pasta) can help.
- Plenty of water: Encourage your child to drink water at regular intervals, especially if they have constipation. Staying hydrated can help loosen stool.
- Personal hygiene: Teach and help your child to maintain hygiene in the perineal area (around the anus). Make sure that they wash gently, clean, and pat dry the area after bowel movements.
- Physical activity: Physical activity, including playtimes and age-appropriate exercises, are important in maintaining healthy bowel function in your child.
When Should You See a Pediatrician?
You should visit a pediatrician to identify the cause of blood in your child’s stool. A proper diagnosis can help manage underlying conditions or rule out any serious problem. Consider taking medical advice if your child experiences the following.
- Severe fatigue or weakness
- Bloody diarrhea
- Dark tarry stools
- Abdominal pain
- Abdominal swelling or distention
[ Read: Constipation In Children ]
Treatment Of Bloody Stool In Children
1. Stool softeners or laxatives: In most cases, fissures are caused because of the passing of hard stool or chronic constipation. Therefore, doctors often recommend stool softeners or laxatives.
2. Topical ointments: In severe cases of fissures or tears because of constipation, stool withholding, or painful bowel movement, doctors may recommend topical analgesic ointments to help reduce pain. Do not use over-the-counter creams or ointments in children without consulting your healthcare practitioner.
3. Antibiotics: Antimicrobials or antiparasitic medicines can be prescribed in the case of infectious colitis or intestinal infections. Treatment is based on the identified bacteria, virus, or parasite.
4. Immunosuppressive and anti-inflammatory agents: Such medications may be recommended by your doctor to manage inflammatory bowel disease (ulcerative colitis). Corticosteroids, aminosalicylates, immunomodulators, etc., are effectively used in children to eliminate symptoms and improve the quality of life.
5. Endoscopic treatment/therapy: Full colonoscopy with endoscopic polypectomy may be used to treat polyps. Juvenile polyps are usually small (around 5-15mm in diameter), and, therefore, doctors may use snare polypectomy that uses heat to cut the polyps.
6. Surgery: Surgery may be an option in children with bleeding due to intestinal obstruction (intussusception), rectal polyp or any vascular anomaly.
[ Read: Autoimmune Diseases In Children ]
The presence of blood in the stool of children is not uncommon. The reasons may vary for rectal bleeding and are usually treatable – some with home remedies and others with medical treatment. However, a visit to your pediatrician or healthcare practitioner should not be delayed if the bloody stool is persistent or frequent.
Do you have any experiences to share on rectal bleeding in children? Do tell them in the comments section below.
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3. Fox, V. L. Gastrointestinal Bleeding In Infancy And Childhood: Gastroenterology Clinics Of North America, 29(1), 37-66.(2000).
4. Lange, P. Anal Fissure: American Pediatric Surgical Association. (2016)
5. Miller, Gale W., Causes Of Gross Rectal Bleeding In Children : (A Review Of Sixty-Eight Cases) Md Theses. Paper 35. (1964).
6. Adolph, V. R., & Bernabe, K. Polyps In Children: Clinics In Colon And Rectal Surgery, 21 (4), 280–285. (2008).
7. The Facts About Inflammatory Bowel Disease: Crohn’s & Colitis Foundation Of America. (2014).
8. Urgancı, N., Kalyoncu, D., & Eken, K. G. Solitary Rectal Ulcer Syndrome In Children: A Report Of Six Cases: Gut And Liver, 7 (6), 752–755. (2013).
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10. Iga Vasculitis – Henoch-Schönlein Purpura: U.S. National Library Of Medicine. (N.D.).
11. Hemolytic-Uremic Syndrome: U.S. National Library Of Medicine. (N.D.).
12. Hemorrhoids: Choc Children’s Hospital Of Orange County (Uc Irvine School Of Medicine). (N.D.).
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15. Anal Fissure-Treatment: National Health Service, Uk. (2018).
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