Bloody diarrhea - causes and therapy

Bloody diarrhea - causes and therapy

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Bloody diarrhea is not a disease, but a symptom of various basic symptoms: constipation, irritable bowel syndrome, intestinal inflammation, hemorrhoids or colon cancer.

Blood in the stool can be light or dark red, solid or liquid, sometimes there are only droplets on the droppings, then it stains them overall. If the blood is bright red, i.e. fresh, it probably comes from the intestine, while dark and coagulated blood comes from the upper sections of the digestive tract.


Blood in the stool is usually harmless: the cause is hemorrhoids or cracks in the skin of the rectum. Colon polyps, which can develop into colon cancer or infections of the intestine, a diaphragmatic rupture or varicose veins in the esophagus are more problematic.

Gastrointestinal infections, anal fissures and blood diseases are further triggers for blood in the stool.

If your diarrhea shows traces of blood and you do not know the cause, you should definitely consult a doctor to clarify the origin, especially if the symptoms occur more frequently.


The doctor first finds out where the blood has its origin. Then he asks how often the patient has to go to the toilet, whether this diarrhea has occurred earlier, what the sufferers have eaten, whether they have injured themselves, etc. It is also important to ask whether people have lost weight in the past few months without to change their diet, whether they had to vomit, dizziness or nausea. Are there basic diseases?

The doctor scans the abdomen like the rectum and uses a stethoscope, examines the blood values, and if there is suspicion, a gastrointestinal or colonoscopy is pending.


Treatment depends on the disease. If the patient suffers from a broken stomach ulcer, ruptured varicose veins or sudden internal bleeding, the doctor first stops the bleeding.

Hemorrhoids are less dramatic. The patient uses ointments and suppositories here. The doctor only desolates them in the case of extreme hemorrhoids. Removal of polyps Specialists with endoscopy Colon cancer can be treated with chemotherapy and radiation therapy as well as with surgery.


Hemorrhoids are tissue pads in the outermost part of the intestine. We popularly say that if someone has a bloody stool, "they have hemorrhoids". But that is wrong: the hemorrhoidal network is not harmful, but as important as the subcutaneous tissue or tonsils. It protects the intestine from the outside.

We do not suffer from “tonsils”, but from “tonsillitis”. So when we "suffer from hemorrhoids", we suffer from the fact that these hemorrhoids enlarge.

When we drain droppings, the sphincter relaxes and the blood tears off the hemorrhoidal tissue. Then it flows back into the hemorrhoids, which swell and close the anus.

The blood vessels in the hemorrhoidal pad can “wear out”. If we press hard, for example in case of constipation, to get the feces out, the cushion increases.

Often we don't notice it at all and the hemorrhoids regenerate themselves. However, if we notice it, it itches in the inner area of ​​the anus and we feel pressure there. We also have blood in the feces, but also within the anus.

Problems with the hemorrhoids can be associated with other causes of blood in the stool. With severe constipation, for example, the hemorrhoids can enlarge as well as cracks in the skin of the end arm and anal fissures.

Not only constipation, but also the opposite, namely severe diarrhea, can overload the hemorrhoids.

There is a widespread notion that people who are very overweight suffer from hemorrhoids. This is not just a prejudice: Being overweight creates permanent pressure on the abdomen - which in turn presses on the hemorrhoids.

On the other hand, it is hardly known that chronic cough also presses on the hemorrhoids and can also lead to blood in the stool.

A genetic weakness of the connective tissue is less common. Since the hemorrhoids also belong to this connective tissue, they fail in their function to effectively close the anus exit and can neither swell and swell fully as their job would.

Are problems with the hemorrhoids embarrassing?

Enlarged hemorrhoids are one of the "intimate complaints" that many people don't like to talk about - often they don't mention the problem to their doctors. This is a mistake.

First, these ailments are not an indication of poor personal hygiene - it is not an infection with bacteria or viruses that particularly affects those who wash their bottoms insufficiently.

Second, hemorrhoids can be treated effectively, and itching, pressure and bleeding disappear.

Third, and most importantly, supposed complaints with the hemorrhoids are sometimes serious illnesses, in the worst case a sign of colon cancer - and it can be fatal.

Consequences of enlarged hemorrhoids

But there is another reason to see a doctor if you have problems with the hemorrhoids. This sometimes leads to follow-up problems that can be extremely uncomfortable.

If the hemorrhoids slip out of the anus, they sometimes get stuck. Blood clots form, thrombosis develops, causing bleeding, severe swelling and pain.

Such slipped hemorrhoids can easily be confused with thrombosis on the anus edge. However, these perianal vein thromboses arise in the veins on the edge of the anus. They also cause bleeding, the blood is dark. Pregnant women and women giving birth are particularly affected. Most of these thromboses heal completely.

Those who suffer from bleeding hemorrhoids for a long time sometimes develop anemia.

Rubber band and surgery

If the hemorrhoids bleed heavily, medical intervention is recommended. With this method, the doctor slips a rubber ring over the enlarged tissue. No blood flows in now and it dies.

If the bleeding is very heavy and persists for a long time, surgery is recommended. The doctors cut out the enlarged tissue. Local anesthesia is usually sufficient, but general anesthesia is sometimes appropriate.

The doctor uses a stapling device for stacker surgery. He removes a ring of enlarged (and superfluous) tissue on the outer; rectum and joins the wound edges with clips. This operation is shorter than traditional methods, causes less pain and heals earlier.

Cause: Crohn's disease

Crohn's disease is shown by:

1) Regular diarrhea. These are slimy, but mostly without blood. However, ulcerative colitis is almost always accompanied by bloody stools.

2) Abdominal pain occurring in episodes, usually in the right lower abdomen. Here there is a risk of confusing the disease with an inflamed appendix. Ulcerative colitis also leads to abdominal pain, but this occurs spasmodically and immediately before bowel movements.

3) weight loss and mild fever. But that is not a must.

As with all serious illnesses, panic is just as bad a guide as carelessness. If you suffer from severe diarrhea that lasts more than three days, combined with mild fever and severe abdominal pain, you should include alternative explanations.

The following questions help:

1) Have I overexcited my bowel in the past few days?

For example, have I drunk a lot of coffee, consumed large amounts of sugar or sugar substitutes, for example in the form of energy drinks, gummy bears, chocolate? Have I drunk a lot of alcohol and / or smoked a lot of cigarettes? Have I consumed a lot of animal fats - belly meat when grilling, roast goose or pork knuckle?

2) Did I not get enough fiber in my intestine, i.e. not ate fruits and vegetables, no legumes such as beans or chickpeas, or no flax seeds, pumpkin seeds etc.?

3) Did the diarrhea start after a meal? Maybe there is an intolerance or food poisoning?

4) Have I just returned from a trip? Could it be a travel diarrhea? This lasts for two to five days, coli bacteria or viruses are the cause.

At the latest when there is blood in the diarrhea, severe abdominal pain and fever, those affected should go to the doctor on the same day.

Crohn's disease affects all layers of the intestinal wall - but not all parts of the intestine are inflamed to the same extent. The exact cause is still unknown, but those affected show a lack of the body's own antibiotics; therefore, many researchers suspect a disturbed immune response on a genetic basis that may be activated by an infection.

The antibiotics are missing, and therefore the intestinal mucosa cannot adequately ward off harmful bacteria. These bacteria then trigger the inflammation.

Crohn's disease primarily attacks the last part of the large intestine, but also affects every other section of the intestine, from the mouth to the anus. Inflammation occurs everywhere - when it heals, it leaves scars that can narrow the intestine.

If the disease is severe, nutrients from the intestine are processed insufficiently. Then weight loss and blood loss will result. The risk of developing colon cancer is increasing.

Cause: ulcerative colitis

Ulcerative colitis affects the upper layers of the mucous membrane on the intestinal wall. Slightly bleeding ulcers form there. The disease usually starts in the rectum, spreads in the large intestine and moves towards the appendix.

In every fourth affected person, the inflammation affects the entire colon. Most sufferers experience episodes of the disease, between which there are longer periods without symptoms.

However, one in ten has no periods without complaints. In every twentieth the inflammation takes on an extreme form: very severe watery diarrhea, high fever and, associated with this, a high loss of water lead to circulatory shock - ulcerative colitis can even lead to death in these people.

In the acute phases, sufferers suffer from diarrhea, the feces mix with blood and mucus and torment the patient up to 30 times a day. Each time they also have stomach cramps, which are extremely painful. Sometimes there is a fever.

The symptoms rarely show up outside the intestine, as inflammation in joints, on the eyes and on the skin.

If only the rectum is affected, diarrhea, which is as slimy as it is bloody, is the safest feature.

Dangerous complications of this disease are possible intestinal paralysis. If the inflammation severely damages the intestinal wall, the muscles there relax, the intestine cannot transport the food supplied and it expands.

High fever occurs and inflammation of the peritoneum threatens. If the doctors do not operate immediately, an intestinal breakthrough is imminent - and it can cost life.

In addition, the risk of colon cancer is greatly increased: chronic ulcerative colitis very often degenerates after ten years.


Chronic constipation - constipation - is much less dangerous than chronic intestinal inflammation. Every fifth person in Germany suffers from this.

The bowel movement hurts and abdominal cramps occur in seizures: If the person has been in the toilet, they still have the feeling that their bowels are not empty. The hard droppings often cause haemorrhoids and cracks at the end of the intestine. Not only are these cracks uncomfortable, they can also cause blood in the stool.

Constipation is often accompanied by severe flatulence. Not only are they uncomfortable, they can expand into a social problem. They can sometimes be suppressed, but embarrassing situations are still the rule: Sometimes those affected let air when they are in the S-Bahn, in the elevator or at a conference.

At the same time, it is very annoying to leave the room to look for an undisturbed place.

Occasional constipation

Occasional constipation is nothing to worry about. Everyone is affected at some point. The most common cause is unusual diet. If, for example, the intestine becomes blocked on a trip to the south, a light laxative helps; some tropical travelers swear by strong coffee. Such constipations usually disappear when our intestines have adjusted to the new diet or when we start eating again.

Such (temporary) constipation can also have psychological causes - as an inheritance from our evolution. Bowel movements in a situation that is perceived as threatening make living beings in nature vulnerable. Those who sit in hostile territory to do their business are defenseless for this time and are a feast for predators and an easy victim for human opponents.

For example, some people have problems with bowel movements in an unfamiliar environment, school leavers who do their social year as well as students who move into the first flat share. For example, with a young man who moved to a fraternity house in the first semester, bowel movements failed for almost two weeks. When he visited his parents, everything was back to normal.

Chronic constipation

In the event of chronic constipation, the doctor is asked to clarify whether there is a serious illness.

Most of the time, the reason for chronic constipation is “only” due to improper nutrition - combined with a lack of exercise. If the intestinal muscles work too slowly, the food stays in the intestine longer, but the intestinal porridge lacks the liquid and this causes constipation.

This sluggishness is particularly triggered by greasy and sweet foods. A lack of physical training also has an effect, because trained abdominal muscles support digestion.

Digestion is particularly beneficial for dried fruit, legumes and linseed. Their effects support liquids, especially water and herbal teas. It swells the fiber and thus increases the volume of the stool, which then leaves the intestine more easily. For chronic intestinal sluggishness it helps to change the food permanently.

When is a colonoscopy recommended?

A colonoscopy is important, in addition to the reasons mentioned, if there is blood in the stool without a known cause, the faeces turn black without the stomach hurting, if there is a primary tumor, if chronic or non-chronic bowel diseases are suspected.

But even if there is pain in the middle and lower abdomen, if someone is excessively overweight and moves little if there is a lack of iron, and if there is severe flatulence over a long period of time, a colonoscopy is recommended.

When is colonoscopy inevitable?

For colonoscopy, those with deformed stools, such as “ribbon pasta”, “coffee beans” or “pencils”, severe diarrhea following constipation, should already have colon cancer, should feel hardness in the abdomen, who suffers from chronic bowel disease. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Working group of the Scientific Medical Societies (AWMF) e.V .: (accessed: 22.08.2019), Crohn's disease, diagnostics and therapy - registration number 021 - 004
  • German Crohn's Disease / Ulcerative Colitis Association Federal Association for Chronic Inflammatory Diseases of the Digestive Tract (DCCV) e.V .: (accessed: 23.08.2019), Inflammation is the central problem in Crohn and colitis
  • Robert Koch Institute: (accessed: August 19, 2019), colorectal cancer
  • Irmtraut Koop: Gastroenterology compact: Everything for clinic and practice, Thieme, 2013
  • Kirsten Khaschei: Hemorrhoids: Detect, Treat, Cure, Stiftung Warentest, 2016

Video: Diarrhea - organisms that cause bloody and watery diarrhea (August 2022).