Hematochezia Red, Maroon-colored Bowel Movements

Blood as seen in the stool can originate anywhere along the intestinal tract. Black stool usually means that the blood is coming from the upper part of the GI tract. The following may be the causes:

• bleeding ulcer
  
• gastritis
• esophageal varices
  
• a tear in the esophagus from violent vomiting

Maroon-colored bowel movements or bright red blood usually suggest that the blood is coming from large bowel or rectum.

• all the causes of black color stool
  
• diverticular bleeding
• vascular malformation
• intestinal infection (such as bacterial enterocolitis)
• inflammatory bowel disease
• tumor
• colon polyps or colon cancer
• Some upper GI causes may result to vomiting blood such as in peptic ulcer disease.
• Red blood in the stool might be due to hemorrhoids.
• Amebiasis, anal fissures, or colorectal cancer.
• Colonic polyps or tumors, diverticulosis,
• Abnormal small vessels called AVMs
  
• Melena, if at least 6 Tablespoons (or 200 milliliters) of blood is lost

Bright red color -

• all the causes of black or maroon color stool
• hemorrhoids
• anal fissures ("cracks" in the anal area)

Diagnostic Tests for Bloody Bowel Movements

• Colonoscopy
• The color of the stool can suggest the location of the bleeding however this is not reliable.
• A definitive diagnosis will require radiographic and/or endoscopic investigation.
  

Diagnosing Stomach Problems with Stool Color

Dark-colored stools may be seen in platelet function disorders, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. Liver disease may include a yellow tone to the skin and whites of eyes (jaundice) and brownish urine.

Black or tarry stools (Melena)

The passage of black, tarry and foul-smelling stools; can be an indication of digested blood in the stool. Other causes are, iron deficiency anemia, cirrhosis, colorectal cancer, disseminated intravascular coagulation, peptic ulcer, or stomach cancer. In advanced cirrhosis (liver disease), the abdomen becomes distended with fluid and ruptured blood vessels in the stomach and esophagus cause bleeding. The person may vomit blood or pass black stools. Very dark stools, for example, may indicate an ulcerative lesion in the higher digestive tract.

Note: The ingestion of black licorice, lead, iron pills, Pepto-Bismol, or blueberries can all cause black stools or false melena. Stools should be tested for the presence of hidden blood.

Blood in the stool (Hematochezia) - the passage of red, or maroon- colored stools. Red or "frank" blood in the stool could be caused by hemorrhoids. Bloody stools can also be seen in amebiasis, anal fissures, or colorectal cancer. Bright red bleeding with bowel movements may be due to hemorrhoids; however, other conditions such as colonic polyps or tumors, diverticulosis, and abnormal small vessels called AVMs also may cause bleeding. Unusually, the bleeding is coming from the upper intestine or stomach. Bleeding such as you describe usually is evaluated by colonoscopy. Blood, as seen in the stool, can originate anywhere along the intestinal tract. A black stool usually means that the blood is coming from the upper part of the GI tract. At least 6 Tablespoons (or 200 milliliters) of blood must have been lost in order to cause passage of melena. Maroon-colored stools or bright red blood usually suggest that the blood is coming from large bowel or rectum. However, sometimes can be caused by massive upper GI tract bleeding. Some upper GI causes of bloody stools can also cause vomiting blood such as in peptic ulcer disease. The color of the stool can suggest the location of the bleeding however this is not reliable. A definitive diagnosis will require radiographic and/or endoscopic investigation.

Black color -

- bleeding ulcer
- gastritis
- esophageal varices
- a tear in the esophagus from violent vomiting

Maroon color -

- all the causes of black color stool
- diverticular bleeding
- vascular malformation
- intestinal infection (such as bacterial enterocolitis)
- inflammatory bowel disease
- tumor
- colon polyps or colon cancer

Bright red color -

- all the causes of black or maroon color stool
- hemorrhoids
- anal fissures ("cracks" in the anal area)

Gray stools

Gray stools pale stools, putty or clay colored stools may be seen in hepatitis, gallbladder disorders, or malabsorption conditions. Bile salts in the stool excreted by the liver give it a normal brown color. Obstruction to bile flow out of the liver (you may see the word "cholestasis"), or liver infections like viral hepatitis (A, B, C, etc.), may produce clay colored stools. Possible causes for clay colored stool result from problems in the biliary system (the drainage system of the gallbladder, liver, and pancreas): Malabsorption problems can cause undigested fat in the stool (steatorrhea) which is characterized by foul smelling, light yellow to gray, greasy or frothy stools. This may also be caused by low bile output.

Orange Stool

Artificial orange or yellow colorings, or other artificial colorings can product orange stools. Where on earth did you ever get the idea that bright yelloe stool indicates excessive bile involvement ? . Nothing coud be further from the truth. It's the opposite. It is the addition of bile into the intestinal tract as part of the digestive process that actually turns the stool brown. Orange stools may be due to certain medications. Beta-carotene (a form of vitamin A) may cause orange stools as a side effect so check any sources of vitamins or supplements, as well as intake of foods high in beta-carotene (carrots, sweet potatoes, etc.). Another possibility is if the stool is more pale-orange, it might indicate lack of bile salt (which gives stool a brownish color). Other sources are antacids containing aluminum hydroxide, barium from recent barium enema test, and hepatitis. Consider checking some baseline liver tests to evaluate proper liver function.

Green Stool

Stool starts out green , then turns bright yellow as it goes through the digestive tract. It is bile and bacteria that finally turn it brown. Yellow or green stools can indicate stool is passing through the digestive tract too rapidly not giving it a chance to change colour. Bright yellow stools can also indicate not enough bile / bilary obstruction. Green stools may be bacteria, or a green or blue food eaten. Green, blue, or yellow artificial colorings too.

What is Diarrhea? Normal & Loose/Excessive Bowel Movements (Diarrhea)

What Is a Diarrhea?

Diarrhea (Greek dia = through, rhein = flowing) means having more than three bowel movements, or passing more than 300g of watery stool daily (1).

NOTE: American English spelling is diarrhea, UK English spelling is diarrhoea.

What Is Not a Diarrhea?

• Ten diapers a day are usual in a 14 days old infant. Three soft bowel movements a day may be considered normal for adult on a fibre-rich diet. Stool soiling in children who are already toilet trained may be due to defective anus. Stool incontinence or mucus seeping in adults may be due to rectal inflammation, rectal prolapse, hemorrhoids, uncoordinated pelvic floor muscles, or anal muscle or nerve damage (2). In all mentioned cases, bowel movements tend to be of normal volume and consistency.
• Occasional single loose stool still isn't a diarrhea. Unripe fruits, green potatoes, spicy or hot food may all irritate the bowel. Insufficiently cooked or chewed food, a heavy sugary or fatty meal may be hard to digest. Wrong food combinations, like meat with sugar, may result in a loose stool. Food which is psychically rejected, after ingesting, might flow through the intestine quickly. Caffeine stimulates peristalsis, as can strong emotions like fear.

Normal Stool

• Stool frequency. A newborn passes its first stool in the first two days. During the first month, breast-fed babies usually have 8-10 stools per day, at one month 4 per day, at four months 2 per day, and a child at four years usually has 1 stool per day (7). Three stools per day down to 3 stools per week may be normal for children and adults on solid food.
• Stool quantity depends on the amount of ingested food and its fiber content. Two liters of mixed food yields about 200g of stool. The more fiber in the diet, the bulkier the stool.
• Stool consistency. A normal stool is semi-solid. Food fibers make stools soft as they tend to bind water. If not enough water is consumed, stools will be hard; on the other hand a lot (up to 20 liters/day) of water consumption will not result in a softer stool, since most of the water is absorbed in the intestine.
• The color of the stool in a healthy adult is any shade of brown, or even green. A green stool may originate from green vegetables, fruit juices, or iron supplements. A newborn's first stool (meconium) is greenish black. A black stool may come from licorice, iron supplements, or Pepto-Bismol. A red stool may originate from beetroot, tomato sauce, red Jelly-O, etc.
• Stool composition: 60-90% of water, the rest are fibers and other undigested substances, bacteria, shed intestinal cells, bile pigments, and minerals.

Mechanisms of Diarrhea

• Osmotic diarrhea. When a particular nutrient (solute) is not absorbed, it attracts water from blood vessels in the intestinal wall (where it is found in lower concentrations) into the intestinal hollow (with high concentrations). This process is called osmosis and occurs after ingestion of large amounts of unabsorbable solutes (e.g. sorbitol), or when nutrients stay within the intestine, because they can't be digested (in lack of digestive enzymes), or absorbed (in inflammation or surgical resection of a part of intestine).
• Secretory diarrhea. Unabsorbed fatty or bile acids trigger water secretion from colonic mucosa; toxins from some bacteria (E. coli, V. cholerae) or some drugs (quinine) have the same effect on the small intestinal mucosa. Secretory diarrhea is watery.
• Exudative diarrhea. From ulcerated intestinal mucosa (in shigellosis, amebiasis, ulcerative colitis), the blood, proteins and pus may exudate and appear in the stool. Exudative diarrhea is often of low volume.
• Motility diarrhea. In increased gut motility (psychic stress, irritant food, bacterial toxins, laxatives, hyperthyroidism) there is not enough time for adequate water and nutrient absorption, thus resulting in motility diarrhea.
• More than one mechanism is usually involved in each diarrheal event.

Diarrheal Stool

• The frequency of diarrheal stool may vary from three a day to twenty a day or more in extreme cases. Over 20 liters of water with electrolytes (potassium, sodium, magnesium) may be lost in one day in severe diarrhea. Diarrheal stool may be anything from clear liquid to soft formed mass.
• Water in diarrheal stools originates from food, unabsorbed digestive juices, or increased intestinal secretion. White diarrheal stool is from unabsorbed fats (>6g fats/day is abnormal), and yellow stool from lack of bile acids. Green diarrhea is from unabsorbed bile acids. Bloody diarrhea is from ulcerated colonic, or (rarely) small intestinal mucosa. Black colored diarrheal stool is from bleeding from the mouth, nose, throat, lungs, esophagus or stomach, or from antidiarrheal drug Pepto-Bismol. Other components of diarrheal stool: undigested substances, mucus, sugars (e.g. lactose), and microorganisms.

Is Diarrhea Harmful?

• In many cases, diarrhea is only an unpleasant event. However, a few liters of body water lost during diarrhea may lead to dehydration within 24 hours, may severely affect metabolism, muscles, nerves, heart, or consciousness, and may cause permanent damage of affected organs. About 2.2 million children die from diarrhea (mostly from dehydration) every year, mostly in countries where medical help is not easily accessible; malnourished children with lowered immunity or chronic diseases are at greatest risk (8). Repeating acute or chronic diarrhea may lead to malnutrition.

Causes of Diarrhea

Main causes of diarrhea are:

• Gastrointestinal infections: viruses (mostly Rotavirus), bacteria (e.g. Escherichia coli, Campylobacter, Salmonella, Shigella), parasites (e.g. Giardia, intestinal worms); primarily non-gastrointestinal infections (e.g. measles, tuberculosis)
• Inappropriate food (artificial sweeteners, overfeeding)
• Psychic factors
• Food intolerance: lactose intolerance, celiac disease, food allergies
• Medication: antibiotics;
• Toxins: pesticides, poisonous plants
• Intestinal disease: e.g. inflammatory bowel disease, lymphoma
• Other abdominal disease: liver, pancreatic, gallbladder disease
• Other causes: AIDS, hyperthyroidism, cystic fibrosis, competitive running, etc.

FODMAPS - Help With Diet

Diet with Low FODMAP: This includes Fructose, fructans, sorbitol, raffinose.

Symptoms of Gastrointestinal disorder include abdominal pain, bloating, wind, reflux, diarrhoea and/or constipation. FODMAPs are a collection of small chain carbohydrates that are poorly absorbable in the body. Fermentation of FODMAPs in the distal small and proximal large intestine stimulates such conditions in the bowel that lead to releasing gas, boost intestinal permeability, an inclination factor to growth of Crohn's disease. FODMAPs are a group of poorly absorbed short-chain carbohydrates in the diet because of their osmotic consequences (diffusion of molecules through a semi-permeable membrane until both sides balanced), increase fecal output following colectomy and ileal pouch formation or ileorectal anastomosis (IRA).

Causes of Green Stool

The following medical conditions are some of the most possible causes of Green stool. There would be other possible causes, so ask your doctor about your symptoms.

   * Salmonella - can cause greenish stool (usually diarrhea)
   * Giardia - can cause greenish stool (usually diarrhea)
   * Swallowed postnasal drip - ie. from an upper respiratory disorder
   * Intestinal disorder
   * Starvation stools - usually in children; green watery stool caused by being on a liquid diet for a few days (e.g. if ill)
   * See also dark stool, blood in stool, or stool color changes
   * Normal breast-fed baby
   * Gastroenteritis
   * Certain foods
   * Some cow milk formulas