Children's Hospital Colorado

Stools - Blood In

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

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  • Blood-colored material mixed in the stool, on the surface or passed alone
  • Blood in the stools is mostly bright red
  • Blood from bleeding in the stomach comes out tar-black
  • Included: Blood from constipation and anal fissure (tear)

Causes of Blood in Stool

  • Anal Fissure. If no diarrhea, most of these children have a small tear in the anus. This is called an anal fissure. Anal fissures usually are caused by passage of a large or hard stool. This is the cause in 90% of children with blood in the stools.
  • Strep Skin Infection. A Strep skin infection around the anus can also cause blood-streaked stools.
  • Bacterial Diarrhea. If also has bloody diarrhea, a gut bacterial infection may be the cause. Examples are Shigella, Salmonella, E.Coli 0157 or Campylobacter.
  • Cow's Milk Colitis. Starts within the first 2 months of life. Causes loose, slimy stools. Can be blood-streaked. Treatment: Need to avoid cow's milk formulas.
  • Blood spreads rapidly and widely in water. Passing a stool with a few blood streaks often turns the toilet water pink. It doesn't mean a large blood loss.

Causes of Red Stools, but not Blood

The things listed below can also cause red-colored stools that look like blood:

  • Certain foods (such as tomatoes or beets)
  • Certain drinks (such as red Kool-Aid)
  • Certain medicines (such as amoxicillin or omnicef)

Anal Fissure or Tear

  • An anal fissure is the most common cause of blood in the stools.
  • It causes blood on the surface of a stool. Blood may also be found on toilet tissue after wiping.
  • The blood is always bright red.
  • Only a few streaks or flecks are seen.
  • You may see a shallow tear at 6 or 12 o'clock on the anus.
  • Caused by passing a large or hard stool.

Call 911 Now

  • Passed out (fainted) or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Lots of blood in stool or blood passed alone without any stool
  • Vomits blood

Call Doctor Now or Go to ER

  • Tarry or black-colored stool (not dark green)
  • Blood with diarrhea
  • Pink- or tea-colored urine
  • Stomach pain or crying also present
  • Skin bruises not caused by an injury
  • Age under 12 weeks
  • After an injury to anus or rectum
  • High-risk child (such as with bleeding disorder or Crohn's disease)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Small amount of blood in the stools. None of the symptoms above. Reason: Most likely an anal fissure or tear. This needs a doctor's input.
  • Note: Try to save a sample of the "blood" for testing.

Care Advice for Anal Fissure

  1. What You Should Know About Anal Fissures:
    • An anal tear is the most common cause of blood in the stools.
    • This is called an anal fissure.
    • It causes blood on the surface of a stool.
    • Blood may also be found on toilet tissue after wiping.
    • It is caused by passing a hard or large stool.
    • Here is some care advice that should help until you talk with your doctor.
  2. Warm Saline Baths:
    • Give a warm salt water bath for 20 minutes.
    • Add 2 ounces (60 ml) of table salt to a tub of warm water. You can also use baking soda.
    • Do 2 times per day for 1 day to cleanse the area and to help healing.
  3. Steroid Ointment:
    • If the anus seems red, use 1% hydrocortisone ointment (such as Cortaid). No prescription is needed.
    • Put a little around the anus.
    • Use 2 times per day for 1 day to help healing.
  4. High-Fiber Diet:
    • For children more than 1 year old, change the diet.
    • Increase fruits, vegetables and grains (fiber).
    • Reduce milk products to 3 servings per day.
    • If Constipation is the cause, see that care guide.
  5. What to Expect:
    • Most often, anal tears heal up quickly with home treatment.
  6. Call Your Doctor If:
    • Bleeding gets worse
    • Small bleeding occurs more than 2 times
    • You think your child needs to be seen
    • Your child becomes worse

Disclaimer

The information contained in these topics is not intended nor implied 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.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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