Red stuff in stools needs assessment

Your 4-year-old tells you she saw some red stuff on the toilet paper when she wiped her bum. Your 4-week-old has blackish-red specks and mucus in her poop. Your 8-year-old wants to know why the water in the toilet looks pink after he pooped. Your 14-year-old says he’s having blood in his poop but he feels fine. Your 6-year-old has had a stomach bug and now has some red stuff mixed in with his poop.

No matter how old your child is and even if you think you know why your child is having red stools, it is important to figure out for sure what is the cause and manage it. Here are the most common causes of red stuff in poop and what to think about before heading in to your appointment to discuss this:

Eating something that colors the stool: Yep, kids eat a lot of crap and sometimes the red food dye can make their stools look red. I have even had a kid eat a crayon, which we figured out later, as the cause of a funky red stool. An antibiotic called Omnicef (cefdinir) is well known for making stools a creepy red color that often freaks out parents. If your child isn’t acting sick at all, consider bringing in a stool sample to your doctor’s office where a simple test can be done to prove whether or not the red you see is blood.

Constipation: When you pass a hard stool, especially if it is big around, you run the risk of tearing the anus just a little as the poop comes out. This can cause some blood to be streaked on the outside of the stool and may color the toilet water a light pink. Constipation is especially common in children around the time they are potty training, but even if you think this is the cause, it is a good idea to get it checked out to be sure. Managing a rectal fissure is pretty easy: softening the stool using diet changes or medication and using Vaseline to make the anus more pliant. But make sure this is the cause.

Infection: Some viruses and bacteria that cause diarrhea can also cause blood in the stool. These may be more serious infections like E. coli or salmonella, so getting evaluated is important. If your child is having high fevers for more than a day or so, not urinating well and acting very listless along with having bloody stools, he needs to be seen by a doctor right away.

Food allergy: This is often the cause of blood in infant stools. Most commonly if a baby under 4 months of age has a food allergy, it is one that irritates the intestine so much that it gets inflamed and bleeds a little. Allergies to dairy and/or soy are most often to blame, but you really need to talk to your doctor about this one. Food allergies in older kids, to eggs or nuts, for example, almost never present with blood in the stool as its symptom.

Colonic polyp: This is uncommon, but kids can have painless red blood in their stool, usually without mucus, as a result of a single polyp in the colon. The good news is that these polyps are benign. The bad news is that the only way to know for sure is to do some invasive studies. We usually try to rule out other causes with exams and lab work first and only resort to the invasive studies when all else fails to give an answer.

Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis: These tend to occur in kids school aged and older, but I have seen cases in children as young as 1 year old. Usually the kids with this will have mucus and blood in their stools and often have looser stools and sometimes more frequent stools than they used to. These children usually lose weight and complain frequently of stomach cramping and upset. This sort of cramping can wake up a sleeping child. We can do some lab tests to see how likely this is the cause of the problem, but sometimes the blood in the stool isn’t visible to anyone so any kid who is having changes in bowel movements with weight loss needs to be seen by a doctor. A definitive diagnosis is made by doing a scope of the intestinal track.

Meckels diverticulum: This is a malformation of the small intestine that can lead to profuse bleeding. Not usually missed!

The bottom line is that blood in the stool, on toilet paper or in the toilet water is never normal and needs assessment.