Gastrointestinal (GI) bleeding: When to See a Doctor

What is gastrointestinal bleeding?

Gastrointestinal (GI) bleeding refers to any loss of blood from your gastrointestinal tract. Blood loss may be overt (visible) or occult (undetectable to the naked eye). If visible, bleeding may manifest in several ways. Very commonly, patients may see blood on the toilet paper after wiping or small drops of blood in the toilet bowl. This type of bleeding is usually associated with bright red blood (fresh blood). Bleeding may also be of larger volume and maroon (dark red) or black in color. It may contain blood clots as well. The volume, color, and associated symptoms (abdominal pain, etc) offer clues regarding the cause of bleeding and are important details to relay to your physician.

What are the causes of GI bleeding?

• Hemorrhoids (both internal and external) – the most common cause of bleeding, it is typically small volume, bright red, and often associated with defecation.
• Anal fissures – also typically small in volume and bright red, but associated with very painful passage of stool through the anal canal. Both hemorrhoidal and bleeding from anal fissures may occur at any age.
• Diverticulosis – much more common over the age of 50, it is associated with very large volume bright red or maroon stools and is not associated with abdominal pain.
• Colitis – a generic term that refers to inflammation of the colon, this may be caused by infections (viruses, bacteria), ischemia, or inflammatory bowel disease (Crohn’s or ulcerative colitis). Bleeding may vary in quantity and color, but is most often maroon or bright red. Mucus may also be seen. Abdominal pain is often present.
• Polyps and colorectal cancers – Depending on the location, bleeding may be of any color (bright red, maroon or black) and is usually not associated with pain.
• Arteriovenous malformation (AVM’s) – benign little blood vessels that lie on the surface of the intestine, they often cause bleeding that is not visible (occult).
• Ulcers – bleeding ulcers typically cause black stools and may be associated with upper abdominal pain or nausea.

When should I seek medical attention for my gastrointestinal bleeding?

Any gastrointestinal bleeding, whether overt or occult, should be evaluated by a medical professional as it may represent a serious underlying condition. Bleeding that is small volume, bright red, or intermittent should be assessed but does not represent an emergency. Bleeding that is larger volume, frequent, black or maroon, or associated with other symptoms (abdominal pain, nausea, etc.) requires urgent evaluation.

It is very important to tell your doctor about any GI bleeding you may be experiencing as soon as possible. Do not attempt to diagnose yourself. Pending evaluation, your doctor may suggest an imaging study (CT), endoscopy or colonoscopy.

Contact us if you would like to make an appointment with one of our physicians at Richmond Gastroenterology.