Patient information: Bloody stools in children (Beyond the Basics)
- George D Ferry, MD
George D Ferry, MD
- Section Editor — Pediatric Gastroenterology
- Professor of Pediatrics
- Baylor College of Medicine
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 "Lower gastrointestinal bleeding in children: Causes and diagnostic approach".)
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
- Inflammatory bowel disease, also known as Crohn's disease or ulcerative colitis, is a condition in which the lining of the bowels become inflamed. The inflammation leads to symptoms, such as bloody stools, diarrhea, lack of appetite, and weight loss. Crohn's disease and ulcerative colitis are discussed in more detail in a separate article. (See "Clinical manifestations of Crohn disease in children and adolescents" and "Management of mild to moderate ulcerative colitis in children and adolescents".)
- Infectious diarrhea is diarrhea caused by a virus, bacterium, or parasite that can cause bloody stools in preschool and school-aged children. Infectious diarrhea can develop as a result of eating or drinking contaminated foods/drinks, or less commonly, after taking a course of antibiotics. (See "Patient information: Food poisoning (food-borne illness) (Beyond the Basics)" and "Patient information: Antibiotic-associated diarrhea caused by Clostridium difficile (Beyond the Basics)".)
Symptoms of infectious diarrhea usually include bloody diarrhea, fever, and abdominal pain. Treatment of diarrhea in children is discussed separately. (See "Patient information: Acute diarrhea in children (Beyond the Basics)".)
- Juvenile polyps are growths that can develop between the ages of two and eight years. Symptoms usually include painless rectal bleeding. Juvenile polyps are not usually cancerous or pre-cancerous but should be evaluated by a healthcare provider and usually require removal.
- A number of other, more serious conditions, including intussusception (a form of bowel obstruction) or Hirschsprung's disease (a form of colon obstruction that develops before birth) can also cause rectal bleeding. Obstruction is the medical term for a blockage in the bowels. Most of these conditions cause the infant or child to become ill suddenly. If your child suddenly develops bloody stools and becomes lethargic, has abdominal pain, fever, or other unusual symptoms, call your child's healthcare provider immediately. (See "Intussusception in children" and "Congenital aganglionic megacolon (Hirschsprung disease)".)
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: 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.
Lower gastrointestinal bleeding in children: Causes and diagnostic approach
Clinical features and diagnosis of necrotizing enterocolitis in newborns
Clinical presentation and diagnosis of inflammatory bowel disease in infants, children, and adolescents
Food protein-induced proctitis/colitis and enteropathy of infancy
Management of necrotizing enterocolitis in newborns
Clinical manifestations of Crohn disease in children and adolescents
Management of mild to moderate 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
- National Institute of Diabetes and Digestive and Kidney Diseases
- Balkan E, Kiriştioğlu I, Gürpinar A, et al. Sigmoidoscopy in minor lower gastrointestinal bleeding. Arch Dis Child 1998; 78:267.
- Latt TT, Nicholl R, Domizio P, et al. Rectal bleeding and polyps. Arch Dis Child 1993; 69:144.
- Teach SJ, Fleisher GR. Rectal bleeding in the pediatric emergency department. Ann Emerg Med 1994; 23:1252.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.