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Quick reference medical handouts used by Pediatric offices


Black or bloody stools in children


Stools that look tarry, black, or bloody can be alarming to parents, but they are not always a sign of serious illness. To understand what to do about this symptom, it is important to recognize which unusual-looking stools are simply bothersome and which require a visit to the doctor. Blood stool indicates bleeding in the digestive tract (gastrointestinal tract), usually in or below the stomach. This can be caused by inflammation, irritation, or infection. Bloody stools may occur as one large loose stool or several stools containing a moderate amount of blood. If your child is toilet trained, there may be enough blood to turn the water in the toilet bowl red. Depending on where the blood is coming from and how quickly it is moving through the digestive tract, the blood may be bright red, reddish brown, black, or tar like (tarry). The blood will be mixed in with the stool.

Stool color What it may mean

Possible dietary causes

Black Bleeding in the upper intestinal tract, such as the stomach. Iron supplements, Pepto-Bismol, black licorice
Bright red Bleeding in the lower intestinal tract, such as the large intestine or rectum. Red food coloring, beets, red Jell-O
Green Food is moving through the large intestine too quickly, such as due to diarrhea. As a result, bile doesn't have time to break down completely. Green leafy vegetables, green food coloring, such as in Kool-Aid or popsicles
Pale or clay-colored A lack of bile. This may indicate a bile duct obstruction. Certain medications, such as large doses of Kaopectate and other anti-diarrheal drugs
Yellow, greasy, foul-smelling Excess fat in the stool, such as due to a malabsorption disorder. Sometimes the protein gluten, such as in celiac disease. But see a doctor for evaluation.
Black Bleeding in the upper intestinal tract, such as the stomach. Iron supplements, Pepto-Bismol, black licorice
Bright red Bleeding in the lower intestinal tract, such as the large intestine or rectum. Red food coloring, beets, red Jell-O

Causes

There are many reasons stools may be black, tarry, or bloody. The most common problems are:

  • Anal fissure An anal fissure is a shallow tear or crack in the skin at the opening of the anus. More than 90% of children with blood in their stools have an anal fissure.
    Symptoms include:
    The blood in the stool is bright red.
    The blood is only a few streaks or flecks.
    The blood is on the surface of the bowel movement (BM) or on the toilet tissue after wiping.
    The child usually passes a large or hard bowel movement just before you notice the blood.
    Parents may see a shallow tear at the opening of the anus when the buttocks are spread apart, usually in a clock position of 6 or 12 o'clock. However, a tear cannot always be seen.
    Touching the tear causes mild pain.
  • Foods. Large amounts of iron or iron-rich foods, such as spinach and beets, can cause stools to temporarily turn black. This change is not cause for concern. The color of the stools will return to normal after a time. Eating foods with black or dark blue food coloring can turn your child's stool black
  • Medications. Iron preparations and stomach medications that contain bismuth compounds (such as Pepto-Bismol) can cause stools to darken or turn black. Stool color will return to normal when you stop taking the medication.
  • Ulcerative colitis. Frequent, mucus-covered bloody diarrhea accompanied by fever and weight loss can be caused by an intestinal disorder called ulcerative colitis. This condition is serious and must be treated by a doctor.
  • Intestinal infection: Rotavirus, salmonella, shigelloses and the like
  • Stomach ulcers and gastritis (stomach inflammation)
  • Trauma or foreign body
  • In a breastfeeding baby, if a mother has a cracked nipple, the infant may ingest some blood from mom (this is not harmful to baby), which may show up in baby's stool.
  • Vascular Diseases - Henoch-Schonlein Purpura, idiopathic thrombocytopenic purpura, etc.
  • Intussusception or Volvulus where there is interruption of the blood supply to the intestine causing death of intestinal tissue if not treated
  • Hemorrhoids
  • Colorectal cancer. While extremely rate in children, blood in the stool can be a symptom of colorectal cancer. This form of cancer may also cause abdominal pain and changes in bowel movements.

How your child's doctor determines the cause of your child's bloody stools

Usually, your child's health care provider 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 doctor can easily 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.

 

updated 05-30-2013

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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