What Can Cause Bloody Stool in Children?

There is blood in the stool from the anus. Whether the stool is bloody or all bloody, the color is bright red, dark red or tar-like, it is called blood in the stool. Blood in the stool usually indicates lower gastrointestinal bleeding, especially colon and rectal bleeding. Blood in the stool with vomiting is a manifestation of upper gastrointestinal bleeding. The color of the stool depends on the location of the bleeding, the amount of bleeding, and the length of time in the intestine. The upper gastrointestinal bleeding is mostly black stools. Can also be dark red or even bright red. Lower gastrointestinal bleeding is mostly bright red or dark red. If you stay in the intestine for a long time, it can also turn into black stools. Black tar-like stools indicate a bleeding volume above 60 ml. Those who have blood in the stool have no vomiting, and those who have vomiting have more black stools. Blood in the stool can also be part of the manifestations of systemic diseases, and sometimes "blood in the stool" can be caused by swallowing blood from outside the digestive tract.

Basic Information

Visiting department: Pediatrics
Common causes: Anal fissures, hemorrhoids, anal and rectal injuries, rectal polyps, bacterial dysentery, etc.

Common symptoms: Bloody stools, bloody stools, or bloody stools
Contagious: no

Causes of pediatric blood in the stool

Common causes of blood in the stool:

Lower digestive tract disease

(1) Anal canal disease Anal fissure and hemorrhoids.

(2) Rectal diseases: Anal and rectal injuries, rectal polyps, rectal tumors, etc.

(3) Colon and small bowel diseases Bacterial dysentery, amoebic dysentery, localized enteritis, intussusception, intestinal tuberculosis, typhoid fever, distal ileum diverticulitis, melanin spot-gastrointestinal polyposis, repeated bowel malformations, small bowel blood vessels Tumor, small intestine tumor, mesenteric artery embolism, etc.

2. Upper gastrointestinal diseases: esophagus, stomach and duodenum, biliary diseases, etc.

3. Systemic and toxic diseases

(1) Hemorrhage, coagulopathy, hemorrhage, neonatal hemorrhage, severe infection, and DIC.

(2) Epidemic hemorrhagic fever, typhoid fever, paratyphoid fever and typhus, leptospirosis, hookworm disease, schistosomiasis, sepsis and so on.

(3) Poisoning or toxic effects of sepsis, bacterial food poisoning, toxic plant poisoning, drug toxic effects, chemical poisoning, etc.

(4) Hereditary hemorrhagic telangiectasia

The above diseases cause intestinal inflammation and ulcers, intestinal blood circulation disorders, gastrointestinal mucosal damage, or increased capillary permeability, leading to blood in the stool.

Clinical manifestations of pediatric blood in the stool

In case of pediatric blood in the stool, you should inquire about medical history and comprehensive physical examination in detail, pay attention to the following points:

Pre-blood test

Before determining blood in the stool, you should carefully check whether it is black stool caused by bleeding in the mouth, nasopharynx, bronchus, and lungs, and exclude blood samples or black stool caused by certain drugs and food.

2. According to the age of the child

Neonatal blood in the stool is mostly due to swallowing blood from the mother's birth canal or nipple rupture or suffering from natural neonatal hemorrhage, hemorrhagic necrotizing enteritis, and digestive tract malformations. Blood in the stool of infants and young children is more common in intussusception, Meckel diverticulum, intestinal polyps, prolapse, anal fissure and so on. Preschool and school-age children's blood in the stool should consider esophageal varices, ulcers, intestinal polyps, anal fissures, and allergic purpura.

3. Blood volume and color in stool

A small amount of blood in the stool is bright red, and the blood is attached to the surface of the stool. Most of it is bleeding from rectal, sigmoid, or descending colon diseases. If the child does not cry when the stool is resolved, consider rectal polyps. Intussusception and so on. A large amount of blood in the stool, dark red or black, mostly upper gastrointestinal or acute hemorrhagic necrotic enteritis, intestinal typhoid and other bleeding. Jam-like stools are bloody and mucus-like jelly-like stools. For example, children aged 6 to 18 months with paroxysmal crying should consider intussusception. Bean soup-like stools: stools are bloody and smelly, and when considering hemorrhagic necrotizing enteritis, children often have abdominal pain and obvious abdominal distension.

4. The relationship between blood in the stool and defecation

Blood drips after stool, and is not mixed with stool. It is more common in internal hemorrhoids, anal fissures, and also found in rectal polyps and rectal cancer. The stool is pus and bloody or the blood is pus-like mucus. Pay attention to dysentery, schistosomiasis, intestinal tuberculosis, and chronic colitis.

5. Other accompanying symptoms

Blood in the stool with severe abdominal pain or even shock should pay attention to mesenteric vascular obstruction, hemorrhagic necrotic enteritis, intussusception; blood in stool with abdominal mass should pay attention to intussusception, tumors, etc .; blood in the stool with bleeding in other parts of the body are more common in blood system diseases, Acute severe infection, vitamin C deficiency, etc .; symptoms of blood in the stool with fever and systemic poisoning are mostly acute infections. Unexplained blood in the stool must be examined by anus and digital rectum, which can help find anal fissures, rectal polyps, hemorrhoids, intussusception, and cancer.

6. Characteristics of common stool blood diseases

(1) Hemorrhoids Generally, anal bleeding caused by hemorrhoids is internal hemorrhoid bleeding. It occurs during or after defecation, and the blood color is bright red. It does not mix with feces, and it will be accompanied by foreign matter coming out of the anus.

(2) Anal fissure Anal fissure is the biggest symptom of pain, red blood, dripping blood, and severe pain after defecation.

(3) The amount of bleeding from anal fistula is not much. The feces are pus and blood, and frequent defecation. The child will also have nausea, dizziness, and bleeding. When the amount of bleeding is large, iron deficiency anemia will occur in patients, and shock will occur in severe cases.

(4) Enteritis bleeding is intermittent, similar to anal fistula bleeding, and the amount of bleeding is not much.

(5) Intestinal polyps are painless and red in color. They are not mixed with feces, often accompanied by mucus flowing from the inside of the anus, with occasional prolapse.

Pediatric stool blood test

Laboratory inspection

Observe the color, blood volume, mucus, pus and blood of the stool, and whether the blood is mixed with the stool. Stool microscopy can reveal the pathological components of intestinal inflammation, parasite eggs and certain parasites (such as amoeba). Blood is convenient for microscopic examination without red blood cells, and a occult blood test should be performed.

Peripheral blood hemoglobin and red blood cell counts help to understand the extent of blood loss. Examination of blood coagulation function. Stool culture, schistosomiasis hatching, immunological examinations such as serum ring egg sedimentation test and lyophilized red blood cell indirect hemagglutination test, Federer's response and Waifer's response.

2. Special inspection

(1) Proctoscopy and sigmoidoscopy can directly understand the lesions, such as internal hemorrhoids, polyps, ulcers, tumors, etc., and can take the contents for microscopy and biopsy.

(2) Fiber colonoscopy can observe deep colonic lesions.

(3) Gastrointestinal barium meal perspective, photos, and barium enema angiography are helpful for the diagnosis of gastrointestinal ulcers, diverticulum, polyps, and tumors.

(4) Selective abdominal angiography and radionuclide scanning are helpful for the diagnosis of gastrointestinal bleeding of unknown cause.

Pediatric stool blood diagnosis

According to the medical history, physical examination and necessary auxiliary examination, the diagnosis can generally be clear.

Pediatric stool blood treatment

Cause treatment

According to the treatment of the cause, the blood in the stool can be cured. Such as neonatal hemorrhage, generally only treatment with vitamin K1 has a significant effect. Blood in the bowel often disappears quickly after intestinal infectious diseases with effective drugs. Blood in the stool caused by systemic infectious diseases should be treated on the basis of comprehensive therapy.

Symptomatic treatment

(1) In general , those who deal with active bleeding should absolutely stay in bed and use sedatives. Closely observe and record the child's mind, pulse, blood pressure and urine output. Keep the airway open and prevent suffocation caused by vomiting.

(2) For those who have a large amount of blood transfusion , blood volume should be actively replenished. Those who donate blood immediately without conditions can first enter dextran, 5% glucose saline or compound sodium chloride solution.

(3) Hemostasis: Choose hemostatic agents according to the nature of bleeding, such as Anluoxue, Phenylethylamine, 6-aminocaproic acid, p-carboxybenzylamine, etc. For upper gastrointestinal bleeding, 4 to 8 mg of norepinephrine can be added to 150 to 250 ml of physiological saline orally or intragastric instillation can have a contractive effect on local mucosal blood vessels. Cimetidine and omeprazole have good hemostatic effects on gastric and duodenal acute mucosal lesions and ulcer bleeding.

3. Surgical treatment

Rectal polyps can be removed under colonoscopy. Multiple polyps of the colon and small intestine. When there is a large amount of blood in the stool for a long time, laparotomy can be performed to remove the concentrated intestine of the polyp to stop bleeding and prevent malignant changes. Intussusceptions such as air or barium enemas cannot be reduced or should be treated surgically for longer than 48 hours. Distal diverticulum and repeated bowel malformations with bleeding can be performed with local bowel resection.

Prognosis of pediatric blood in the stool

Depending on the primary disease.

Pediatric stool blood prevention

Once blood in the stool is found, it should be diagnosed and treated in time to avoid delay. Also suggested:

1. Let children develop the habit of regular bowel movements.

2. Reduce the posture that increases abdominal pressure, such as squatting and holding your breath. Avoid sedentary, long standing, long running and overworked.

3. Avoid hot, greasy, rough, scum food.