Blood in the stool

Visible blood on the stool, on the paper or in the toilet bowl is always a reason for a medical assessment. It is not a symptom that makes sense to watch for several weeks, and it is not a symptom you can reliably explain yourself.

The colour tells you something about where the bleeding is, but not everything. Bright red blood that is only on the paper or on the surface of the stool most often comes from the back passage or rectum. Darker blood mixed into the stool points to a source higher up in the bowel. Black, sticky and foul-smelling stool means bleeding in the stomach or duodenum.

Bleeding can also be hidden, i.e. invisible to the naked eye. It then shows up indirectly, as anaemia, tiredness and pallor, or as a positive result of a screening test for blood in the stool.

When to seek emergency help immediately

Call 112 if you have heavy bleeding from the back passage that does not stop, and with any bleeding accompanied by dizziness, pallor, a cold sweat, a fast heartbeat or a feeling that you are going to faint.

Black, tarry stool and vomiting blood require immediate treatment at an emergency medical service, even if you feel well.

You also need an immediate assessment if the bleeding comes with severe abdominal pain, a tense abdomen and fever. If you take blood-thinning medicines, the threshold for emergency care is lower, not higher.

Why concluding that it is haemorrhoids is not safe

Haemorrhoids are indeed the most common cause of visible blood, and for many people that is the explanation in the end. The problem is that haemorrhoids are also so common that many people whose blood is actually coming from somewhere else have them too.

The same picture can come from an anal fissure, diverticula, inflammatory bowel disease, a polyp or cancer of the colon and rectum. Polyps and early cancer often do not hurt and do not change bowel habits until they progress.

Concluding that it is haemorrhoids is therefore not a conclusion that can be reached at home. It is reached after an examination, when the source of the bleeding is visible or other causes have been ruled out.

What accompanies the bleeding and what is important to mention

Everything you have noticed is useful at the examination: how much blood there was, whether it was on the paper or mixed into the stool, whether it was painful, how long it has been going on and whether the shape or frequency of your bowel movements has changed.

Particular weight is given to a change in bowel habits lasting more than a few weeks, unintentional weight loss, needing to open your bowels at night, a feeling of incomplete emptying, tiredness and bowel diseases in close family.

Some foods and medicines colour the stool without any blood being present. Beetroot can turn stool or urine reddish, while iron preparations and some bismuth preparations turn stool black. This is worth mentioning, but it is not a reason to postpone the examination.

How care proceeds

The examination starts with a conversation and an examination of the abdomen, followed by a rectal examination and, at the doctor's discretion, anoscopy to assess the anal canal. Blood is often taken for a full blood count and iron stores.

Colonoscopy is the examination that answers the question of where the bleeding comes from most directly. As well as viewing the lining, it allows samples to be taken and polyps to be removed during the procedure itself. Bowel preparation is essential for it, and you receive the instructions when you book.

Separate from this is Program Svit, the national screening programme for colorectal cancer, which is intended for people without symptoms. Visible blood is not a reason to wait for a screening invitation, but a reason for care now.

Colonoscopy is carried out with a referral under the Health Insurance Institute of Slovenia (ZZZS) and on a self-pay basis, while proctological care is self-pay. Appointments are booked with the clinic that runs the service.