Blood in the stools is a major source of concern for parents. It can be either fresh (hematochezia) or chemically changed black in color (melena[1]). It is critical to determine if the red color in the feces is related to blood in dubious circumstances. Melena can be simulated by ingesting iron or bismuth-containing medicines, or by eating soil or charcoal (pica). Confirming the existence of blood chemically is a recommended practice.
How much blood has been found in your stools? Is there any mucous in it? Is it a basic coating or streaks on a well-formed stool? Do you have any additional symptoms such as diarrhea, constipation, painful defecation, stomach discomfort, vomiting, fever, epistaxis, or bleeding from other places? Have you ever had a worm infestation, pica, medications, or tonsil surgery?
If the youngster is in shock from substantial blood loss, a physical examination should be performed. Look for hemangioma, purpura, telangiectasia, intestinal obstruction, and blood dyscrasias. Examine the nasal passages for symptoms of epistaxis and anus, as well as the rectum for fissures, polyps, and haemorrhoids. You must look for indications of abdominal trauma if you have an acute abdomen.
Not only the feces but also the urine must be examined. Blood stains on the napkin might be caused by hematuria.
It is recommended to do sigmoidoscopy if there is evidence of rectal polyp or colitis.
Swallowed Maternal Blood
This is the most prevalent cause of blood in a newborn’s feces, especially during the first three to four days of life. The blood is ingested either during birth or afterward as the infant sucks on the breast. It’s generally crimson and mixed up with the meconium. The infant looks to be in good health overall.
If you want to be sure it’s maternal blood, filter it and mix one part 0.25 N (1%) NaOH with five parts supernatant fluid. The color turns yellow when maternal blood is present. If the color persists, it is fetal blood, indicating that the infant is suffering from hemorrhagic illness.
Hemorrhagic Disease of the Newborn
Blood in the stools is sometimes accompanied by additional symptoms such as epistaxis, hematemesis, and bleeding from the umbilical cord, skin, and viscera. The time it takes for prothrombin to bind to platelets is increased. In the vast majority of situations, clotting time may be extended as well. On the second or third day of life, the illness appears. Vitamin K insufficiency appears to be the most likely cause of the disease.
Necrotizing Enterocolitis
Apart from bloody diarrhea, the newborn (typically low birth weight, delivered before term) experiences lethargy, vomiting, abdominal distention, hypothermia, and apnea with this disease. The baby is critically unwell and may succumb to cardiovascular collapse at any time.
Maternal fever, amnionitis, sepsis, respiratory distress syndrome (typically moderate), umbilical artery catheterization in exchange transfusion, and oral feeding with high osmolar (hypertonic) stuff are all predisposing variables.
Air-fluid levels, dilated loops of the gut, separation of loops of the gut and linear streaks of intraluminal air, and pneumatosis intestinalis are some of the screened radiologic indications.
Dysentery
Dysentery is perhaps the most prevalent cause of blood in the feces in older babies and children.
Shigella infection causes the most common type. Tenesmus, toxaemia, fever, stomach discomfort, and distention are all common symptoms. Salmonella and E. coli are two other bacilli that have a comparable but mild clinical presentation.
Dysentery is a symptom of E. histolytica, L. giardia, H. nana, Strongyloides sterocoralis, and T. trichiura infection in the intestine. In some parts of the world, bilharzia is the most common cause of bloody diarrhea. Hookworm is a common cause of blood in the feces (most often melena), but not dysentery.
Gastritis
Gastritis (inflammation of the stomach mucosa) in young children and melena in older children may be the cause of blood in the feces. Gastrointestinal bleeding is commonly caused by Ryletube damage and stress ulcers.
Polyp
Internal polyps, particularly rectal polyps, produce significant but painless bleeding in the majority of cases. The diagnosis is made on the basis of the rectal examination, rectosigmoidoscopy, and barium enema should be performed. The most typical location is around ten centimetres above the anus.
Intussusception
Episodic stomach discomfort, vomiting, fever, and prostration accompany the rectal passage of crimson mucus. Tenderness and distension in the abdomen can be observed. In the early stages, a sausage-shaped mass in the upper abdomen may be felt. A cervix-like lump and blood on the inspecting finger are possible findings during a rectal examination.
An X-ray of the abdomen may reveal the lack of intestinal gas in the right lower quadrant as well as dilated small bowel loops.
A barium enema may reveal intussusception as an inverted cap and a block to barium absorption. The column of barium may have a ceiling-spring appearance in the location of intussusception.
If there are no indications of strangling, perforation, or severe toxicity, conservative hydrostatic reduction yields satisfactory results in the vast majority of instances.
Meckel Diverticulum
A substantial amount of blood (typically dark red) is lost in the feces in this situation. If there is any abdominal discomfort, it is mild.
The patient, who is often under the age of two, appears pale and may be in shock as a result of a large amount of blood loss. Children with Turner syndrome are more likely to have Meckel diverticulum. Laparotomy is the only way to confirm the diagnosis, which is characterized by a high level of suspicion.
Anal Fissure
If a child passes a little amount of bright red blood that appears to create a covering over hard stools and the parents report that the child has uncomfortable defecation, the anal fissure should be examined. The condition can be caused by firm stools or the use of a rectal thermometer. An inspection of the anus can help to determine the diagnosis.
Blood Dyscrasias
Idiopathic thrombocytopenic purpura (ITP), anaphylactoid purpura (Henoch-Schönlein purpura), leukemias, hemolytic uremic syndrome, and disseminated intravascular coagulopathy (DIC)are all conditions that can cause profuse blood loss in the stools.
Remaining Causes of Blood in Stools
Cow’s milk allergy, ulcerative colitis, Crohn’s disease, intestinal hemangiomas, hiatal hernia, esophageal reflux, esophageal varices, peptic ulcer, hypertrophic pyloric stenosis, intestinal duplication, haemorrhoids, and foreign bodies are some of the remaining causes of blood in the stools.
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