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Patient information: Bloody stools in children (Beyond the Basics)

INTRODUCTION

Seeing blood on your child's stool can be frightening. However, this is a common condition in children and is usually not serious. There are many possible causes of bloody stools, with the most likely cause depending upon your child's age. A healthcare provider can help to determine the source of the bleeding and the most appropriate treatment.

This article will review some of the common causes of bloody stools and tests that may be used to evaluate your child. Bloody stools in adults is discussed separately. (See "Patient information: Blood in the stool (rectal bleeding) in adults (Beyond the Basics)".)

WHEN TO SEEK HELP

Most children with minor rectal bleeding do not have a serious condition. However, it is not possible to know the cause of rectal bleeding without an examination. Thus, if you notice that your child has rectal bleeding, you should talk to your child's healthcare provider to determine if an examination is needed. (See 'Rectal bleeding tests' below.)

TYPES OF RECTAL BLEEDING

There are two possible sources of bloody stools: the upper digestive tract (stomach and small intestine) and the lower digestive tract (the colon, rectum, and anus).

  • Bleeding from the upper digestive tract usually causes black, tarry stools.
  • Bleeding from the lower digestive tract usually causes the stool to be coated or mixed with bright red blood.
  • Certain foods and medications can also cause the stool to appear bloody. A list of these foods and medications is provided in table 1 (table 1).

However, it is not always possible to know the source or type of rectal bleeding based upon the appearance of the stool alone. An evaluation and physical examination is necessary in most cases. (See "Diagnostic approach to lower gastrointestinal bleeding in children".)

RECTAL BLEEDING CAUSES

Anal fissure — An anal fissure is a tear or crack in the anus that can develop when an infant or child passes a large or hard stool. Anal fissures can occur in all age groups, from newborns to school-aged children and even adults. (See "Patient information: Anal fissure (Beyond the Basics)".) The symptoms of an anal fissure include pain, straining or grunting during a bowel movement, and bright red blood on the outside of the stool or with wiping.

Many infants and children with anal fissures also have a history of constipation or fairly hard stools. Treatment of constipation is discussed separately. (See "Patient information: Constipation in infants and children (Beyond the Basics)".)

Milk or soy protein intolerance — Milk or soy protein intolerance, also known as milk allergy, milk-induced enterocolitis, or protein-induced proctitis or proctocolitis, is a condition that can develop in infants. It is caused by a sensitivity to the protein in cow's milk or soy, and usually develops after starting formula. It can also occur in infants who breastfeed as a result of cow's milk or soy products consumed by the mother. The protein intolerance usually resolves by one year of age.

Symptoms of milk or soy protein intolerance may include vomiting and diarrhea, in addition to blood-tinged or bloody stools. If milk or soy protein intolerance seems to be the most likely cause after an evaluation by the medical provider, a milk-free diet is often prescribed. This is described in a separate article. (See "Patient information: Acid reflux (gastroesophageal reflux) in infants (Beyond the Basics)", section on 'Milk-free diet'.)

Less common causes

RECTAL BLEEDING TESTS

Sometimes a clinician can determine the cause of the bleeding by inspecting the outside of the anus. This may include a brief examination of the inside of the anus using a finger (rectal examination). The clinician can also test a sample of stool to be sure whether or not it contains blood.

This examination may be all that is necessary. If the cause of the bleeding is not clear based upon the examination, further testing may be recommended. This might include a colonoscopy, which is an examination of the inside of the lower part of the gastrointestinal tract (also known as the colon or large bowel). Imaging tests (x-ray or ultrasound examinations) might also be helpful in some cases. The clinician chooses between these tests depending on the child’s history and symptoms.

RECTAL BLEEDING TREATMENT

As discussed above, there are a number of potential causes of bloody stools. Your child's healthcare provider will determine if the underlying condition requires treatment. Even if your child's bleeding seems minor or resolves on its own, your child should be evaluated by a healthcare provider.

WHERE TO GET MORE INFORMATION

Your child's healthcare provider is the best source of information for questions and concerns related to your child's medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Bloody stools (The Basics)

Patient information: GI bleed (The Basics)
Patient information: Angiodysplasia of the GI tract (The Basics)
Patient information: Meckel’s diverticulum (The Basics)
Patient information: Ulcerative colitis in children (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: Blood in the stool (rectal bleeding) in adults (Beyond the Basics)
Patient information: Anal fissure (Beyond the Basics)
Patient information: Constipation in infants and children (Beyond the Basics)
Patient information: Acid reflux (gastroesophageal reflux) in infants (Beyond the Basics)
Patient information: Food poisoning (food-borne illness) (Beyond the Basics)
Patient information: Antibiotic-associated diarrhea caused by Clostridium difficile (Beyond the Basics)
Patient information: Acute diarrhea in children (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Diagnostic approach to lower gastrointestinal bleeding in children
Clinical features and diagnosis of necrotizing enterocolitis in newborns
Clinical presentation and diagnosis of inflammatory bowel disease in children and adolescents
Food protein-induced proctitis/colitis and enteropathy of infancy
Management of necrotizing enterocolitis in newborns
Clinical manifestations of Crohn's disease in children and adolescents
Treatment of ulcerative colitis in children and adolescents
Intussusception in children
Congenital aganglionic megacolon (Hirschsprung disease)

The following organizations also provide reliable health information.

  • National Library of Medicine

     (www.nlm.nih.gov/medlineplus/ency/article/003130.htm)

  • National Institute of Diabetes and Digestive and Kidney Diseases

     (http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/)

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Literature review current through: Jul 2014. | This topic last updated: Jan 28, 2014.
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