Blood in your stool: when it is piles, and when it is not

Seeing blood in the toilet is frightening, and the first thing almost everyone does is decide it is piles. Most of the time they are right. The problem is the times they are wrong, because those are exactly the cases where waiting costs the most.

The colour tells a story

Bright red blood, on the tissue or on the surface of the stool, usually comes from low down near the back passage. That is the pattern haemorrhoids most often make.

Dark red blood mixed through the stool suggests the source is higher up in the bowel.

Black, tarry stool can mean bleeding from the stomach or upper gut, where blood is partly digested on the way down. This one is not a wait-and-see symptom. It needs seeing today.

None of these colours is a diagnosis on its own, but each points us in a direction.

Why piles are the usual answer

Haemorrhoids are swollen blood vessels around the back passage and they are extremely common. Straining, constipation, pregnancy and long hours sitting all bring them on, and in Lagos traffic alone plenty of people qualify. They bleed bright red, often itch or ache, and the blood usually sits separate from the stool rather than mixed into it.

If that is your picture and you are young with no other symptoms, it is very likely piles, and there is a great deal we can do about them.

The signs that mean it is not just piles

Take the bleeding more seriously, and come in sooner, if any of these are also true:

• The blood is dark, or mixed through the stool rather than on the surface
• Your bowel habit has changed and stayed changed for more than two weeks
• You are losing weight without trying
• You feel tired and your blood count is low
• You are over 45, or bowel cancer runs in your family
• There is pain that is new and persistent

Any one of these means the bleeding deserves a proper look at the bowel, not another tube of cream.

The age when bleeding always earns a colonoscopy

From around 45, new rectal bleeding is worth a colonoscopy even when it looks exactly like piles. There are two reasons. First, this is the age at which bowel cancer starts to appear. Second, and more importantly, early growths often bleed in a way that mimics haemorrhoids perfectly.

This is not us expecting the worst. It is that a colonoscopy either rules it out completely, which is the usual outcome and a genuine relief, or catches something while it is still nothing. Both are good mornings.

What we do to find the source

A colonoscopy lets us see the whole large bowel and settle the question directly. If it is piles, we can often treat them in the same sitting with banding. If it is a polyp, we remove it. If we see something that needs a closer answer, we take a biopsy and get you into the right care quickly.

Either way you leave knowing, instead of wondering, and that is the point.

The one thing not to do

Do not spend two years deciding it is piles. That is the story we see most often in Lagos, and it is the one with the worst endings. If your bleeding fits the simple picture and you are young, treat it and keep an eye on it. If anything on the list above applies, come in.

It is one appointment against a question you really do not want to leave open. Call the unit on 070 7056 6272 or send a WhatsApp message and we will arrange it.