The presence of blood in a child’s stool can be a worrisome sight for the parents. But you should note that blood passing with stool does not always indicate any serious internal complications or disease. Most health practitioners have reported that it is a common occurrence in children and requires minimal to no treatment (1). However, this condition might not be as mild as in others in some cases when it is accompanied by pain and other symptoms. In such cases, contact the doctor immediately. Read on to know more about the causes, treatment, remedies, and prevention of blood in a child’s stool.
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:
Chocolate Flavored gelatin Kool-Aid or similar beverages Beets Red licorice Iron supplements Antibiotics (ampicillin) Bismuth preparations (Pepto-Bismol)
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).
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 IgA 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 A Child’s Stool
Bloody diarrhea or blood in your child’s stool followed by diarrhea is not common. It could occur due to an underlying condition, such as (1, 3):
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 A Child’s Stool
The presence of mucus and blood in the child’s stool can be caused due to the following conditions (1, 3, 8, 13).
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). The doctor may also recommend further tests for your child (3, 14).
Colonoscopy, the most preferred diagnostic technique for rectal bleeding. Stool evaluation and culture (e.g., Wright stain) Complete blood count Ultrasound of the abdomen Ultrasonography 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
These simple tips and dietary changes may help your child get some relief from the painful or bloody rectum (1, 15).
When You Should 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
Treatment Of Bloody Stool In Children
The line of treatment for rectal bleeding can depend on the underlying cause (1, 3, 14).
- 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.
- 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.
- 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.
- 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.
- 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 recommend a snare polypectomy, which uses heat, to cut the polyps.
- Surgery: Surgery may be an option in children with bleeding due to intestinal obstruction (intussusception), rectal polyp or any vascular anomaly.
