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Should Your Child See a Doctor?

Stools, Blood In

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Definition

  • Blood-colored material mixed in with the stool, on the surface or passed separately 
  • Blood in the stools is usually bright red 
  • Blood from bleeding in the stomach comes out tar-black 

Causes 

  • Anal Fissure: If no associated diarrhea, more than 90% of children with blood in the stools have an anal fissure. Anal fissures usually are caused by passage of a large or hard stool.
  • A Strep skin infection around the anus can also cause blood-streaked stools.
  • If associated diarrhea, most of the children have Shigella, Salmonella or Campylobacter infections.
  • Some foods (e.g., tomatoes or beets) and drinks (e.g., red Kool-Aid) and some medicines (e.g., amoxicillin or omnicef) can also cause red-colored stools that look like blood.

When to Call Your Doctor for Blood in the Stools

Call 911 If…

 
  • Your child has fainted or is too weak to stand
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Large amount of blood, blood alone without any stool or the toilet water turned red
  • Tarry or black-colored stool (not dark green)
  • Blood with diarrhea
  • Pink- or tea-colored urine
  • Vomited blood
  • Abdominal pain or crying also present
  • Skin bruises not caused by an injury
  • Age under 12 weeks
  • Small bleeding occurs over 2 times
  • Followed an injury to anus or rectum
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • Blood in the stools, but none of the symptoms described above (Reason: probable anal fissure)
  • NOTE: Try to save a sample of the "blood" for testing if your child needs to be seen
 

Home Care Advice for Anal Fissure (Pending Talking with Your Doctor)

  1. Definition: An anal fissure is the #1 cause of blood in stools
    • The blood is bright red, but only a few streaks or flecks are present
    • All the blood is on the surface of the stool or on the toilet tissue after wiping
    • Usually follows passage of a large or hard stool
    • You may see a shallow tear at 6 or 12 o'clock on the anus
     
  2. Warm Saline Baths: Give warm saline baths for 20 minutes 2 times per day for 1 day to cleanse the area and to promote healing. Add 2 ounces (60 ml) of table salt or baking soda to a tub of warm water.
  3. Steroid Ointment: If the anus seems irritated, apply 1% hydrocortisone ointment (no prescription needed) 3 times per day for 1 day to help healing.
  4. High-Fiber Diet:
    • For children more than 1 year old, offer a nonconstipating diet.
    • Increase fruits, vegetables and grains (fiber).
    • Reduce milk products to 3 servings per day.
    • If Constipation is definitely the cause, see that topic.
     
  5. Expected Course: Anal fissures usually heal up quickly with home treatment.
  6. Call Your Doctor If:
    • Bleeding increases in amount
    • Small bleeding occurs over 2 times
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Boyle JT. Gastrointestinal bleeding in infants and children. Pediatr Rev. 2008;29(2):39-52.
  2. Nelson JS. Red stools and Omnicef. J Pediatr. 2000; 136: 853-854.
  3. Silber G. Lower gastrointestinal bleeding. Pediatr Rev. 1990;12:85-92.
  4. Squires RH Jr. Gastrointestinal bleeding. Pediatr Rev. 1999;20(3):95-101.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/22/2010 4:12:15 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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