Stools - Blood In  
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Does this describe your child's symptoms?

Definition
  • Blood-colored material mixed in with the stool, on the surface or passed separately
  • Blood in the stools is usually bright red
  • Blood from bleeding in the stomach comes out tar-black

Causes

  • Anal Fissure: If no associated diarrhea, more than 90% of children with blood in the stools have an anal fissure.  Anal fissures usually are caused by passage of a large or hard stool.
  • A Strep skin infection around the anus can also cause blood-streaked stools.
  • If associated diarrhea, most of the children have Shigella, Salmonella or Campylobacter infections.
  • Some foods (e.g., tomatoes or beets), drinks (e.g., red Kool-Aid), and medicines (e.g., amoxicillin or omnicef) can also cause red-colored stools that look like blood.
When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Fainted or too weak to stand
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Large amount of blood, blood alone without any stool or the toilet water turned red
  • Tarry or black-colored stool (not dark green)
  • Blood with diarrhea
  • Pink- or tea-colored urine
  • Vomited blood
  • Abdominal pain or crying also present
  • Skin bruises not caused by an injury
  • Age under 12 weeks
  • Small bleeding occurs over 2 times
  • Followed an injury to anus or rectum
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • Blood in the stools, but none of the symptoms described above (Reason: probable anal fissure)
  • NOTE: Try to save a sample of the "blood" for testing if your child needs to be seen
HOME CARE ADVICE FOR ANAL FISSURE (until you talk with your doctor)

  1. Definition: An anal fissure is the #1 cause of blood in stools
    • The blood is bright red, but only a few streaks or flecks are present
    • All the blood is on the surface of the stool or on the toilet tissue after wiping
    • Usually follows passage of a large or hard stool
    • You may see a shallow tear at 6 or 12 o'clock on the anus
  2. Warm Saline Baths: Give warm saline baths for 20 minutes 2 times per day for 1 day to cleanse the area and to promote healing. Add 2 ounces (60 ml) of table salt or baking soda to a tub of warm water.
  3. Steroid Ointment: If the anus seems irritated, apply 1% hydrocortisone ointment (no prescription needed) 3 times per day for 1 day to help healing.
  4. High-Fiber Diet:
    • For children more than 1 year old, offer a nonconstipating diet.
    • Increase fruits, vegetables and grains (fiber).
    • Reduce milk products to 3 servings per day.
    • If CONSTIPATION is definitely the cause, see that topic.
  5. Expected Course: Anal fissures usually heal up quickly with home treatment.
  6. Call Your Doctor If:
    • Bleeding increases in amount
    • Small bleeding occurs over 2 times
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/15/2011

Last Revised: 8/1/2011

Content Set: Pediatric HouseCalls Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.