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| Quick reference medical handouts used
by Pediatric offices |
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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
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| 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:
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The blood in the stool is bright red. |
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The blood is only a few streaks
or flecks.
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The blood is on the surface of
the bowel movement (BM) or on the toilet tissue after wiping.
|
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The child usually passes a
large or hard bowel movement just before you notice the blood.
|
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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.
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- 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.
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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