What is the term for rectal bleeding (blood in stool)?

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Last updated: March 16, 2025 • View editorial policy

From the Guidelines

The medical term for rectal bleeding, or blood in stool, is hematochezia. This refers specifically to the passage of fresh, red blood from the rectum, often mixed with or coating the stool. Hematochezia typically indicates bleeding from the lower gastrointestinal tract, such as the colon or rectum. Common causes include hemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease, polyps, or colorectal cancer. The bright red appearance distinguishes it from melena, which refers to black, tarry stools resulting from upper gastrointestinal bleeding where blood has been partially digested.

Key Considerations

  • Any instance of blood in stool should prompt medical evaluation, as it can range from benign conditions like hemorrhoids to more serious issues requiring immediate treatment.
  • The color, amount, and accompanying symptoms help physicians determine the source of bleeding and appropriate treatment.
  • Even small amounts of rectal bleeding should not be ignored, especially in individuals over 40 or those with a family history of colorectal cancer, as noted in recent guidelines 1.
  • A precise patient history and a careful physical examination are essential for accurate diagnosis, as emphasized in the American Gastroenterological Association technical review 2.

Diagnostic Approach

  • Current practice guidelines from both the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract advocate a minimum of anoscopy and flexible sigmoidoscopy for bright-red rectal bleeding, as discussed in 2.
  • Complete colonic evaluation by colonoscopy or air-contrast barium enema is indicated when the bleeding is atypical for hemorrhoids, when no source is evident on anorectal examination, or when the patient has significant risk factors for colonic neoplasia.
  • The decision to pursue further evaluation also depends on the patient’s age and general medical condition, highlighting the importance of a tailored approach based on individual patient factors 3.

Recent Guidelines and Recommendations

  • The most recent guidelines from 2021, such as those from the World Journal of Emergency Surgery 4 and the Journal of the American College of Radiology 1, emphasize the importance of prompt evaluation and appropriate management of lower gastrointestinal tract bleeding.
  • These guidelines suggest the use of ano-proctoscopy or flexible sigmoidoscopy as the first-line diagnostic tool for suspected bleeding anorectal varices and recommend urgent colonoscopy within 24 hours of presentation for patients with high-risk features or evidence of ongoing bleeding 4.

From the Research

Definition of Rectal Bleeding

  • The term for rectal bleeding, or blood in stool, is referred to as hematochezia 5, 6, 7, 8.
  • Hematochezia is defined as the passage of blood or clots from the rectum 5.

Characteristics of Hematochezia

  • Hematochezia can be quite alarming and is a common complaint in adult patients 5, 6.
  • It is characterized by the passage of bright red blood per rectum 7.
  • The bleeding can be associated with various underlying conditions, including anal causes, colorectal cancer, hemorrhoids, and other gastrointestinal pathologies 5, 9, 6, 7, 8.

Clinical Evaluation of Hematochezia

  • The evaluation of hematochezia involves a detailed medical history, physical examination, and diagnostic tests such as colonoscopy and anoscopy 9, 6, 7.
  • Clinical symptoms associated with hematochezia, such as the amount and frequency of bleeding, weight loss, and change in bowel habits, can provide valuable information for diagnosis 7.
  • However, the physician's clinical assessment may not reliably predict the presence of substantial pathology, and further diagnostic testing is often necessary 7.

References

Guideline

anorectal emergencies: wses-aast guidelines.

World Journal of Emergency Surgery, 2021

Guideline

anorectal emergencies: wses-aast guidelines.

World Journal of Emergency Surgery, 2021

Research

Consider colonoscopy for young patients with hematochezia.

The Journal of family practice, 2004

Research

The outpatient evaluation of hematochezia.

The American journal of gastroenterology, 1998

Research

Lower gastrointestinal bleeding.

Gastroenterology clinics of North America, 2003

Research

Anorectal conditions: hemorrhoids.

FP essentials, 2014

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.