One of the many symptoms of inflammatory bowel disease (IBD) is bleeding. Blood or blood in the stool can be frightening. While it can be a sign of an emergency, it is sometimes part of a flare-up of IBD.
IBD is the term for two gastrointestinal disorders with chronic inflammation – ulcerative colitis and Crohn’s disease. In either case, blood may appear in or on the stool. Some people may sometimes not have a bowel movement at all, just blood.
Rectal and large bowel bleeding from IBD is usually red or bright red. Blood from higher in the digestive tract may appear as dark or black stools. In most cases, this bleeding is slow and steady.
This article discusses how bleeding can occur in ulcerative colitis and Crohn’s disease. It covers symptoms to look out for and how to usually treat it.
ulcerative colitis bleeding
Ulcerative colitis causes inflammation and ulcers called ulcers in the large intestine. Blood in the stool is more common in ulcerative colitis than in Crohn’s disease.
The inflammation of ulcerative colitis usually involves the rectum. Because the rectum is at the end of the large intestine, blood from this source is very visible in or on the stool.
Ulcerative colitis can also bleed because this form of IBD attacks the lining (mucosa) of the large intestine. Ulcers that form in the lining of the large intestine tend to bleed.
In some cases, bleeding from ulcerative colitis can lead to massive blood loss. The ultimate goal of treatment will be to calm inflammation and stop bleeding. Treatment of blood loss may also be necessary.
Blood loss from ulcerative colitis can lead to anemia, which is a low red blood cell count. Mild anemia can be treated by supplementing with iron, folic acid, and vitamin B12 to help form new blood cells. In more severe cases of blood loss, a blood transfusion may be required to receive blood from a donor.
The most severe bleeding (called hemorrhage) caused by ulcerative colitis can be life-threatening. This is uncommon, but surgery may be necessary if the bleeding cannot be stopped. This procedure involves removing the colon and making an ileostomy, an opening in the abdomen to drain waste.
In ileostomy surgery, the large intestine is removed. An opening or stoma is created so that waste can enter outside the body into a bag worn around the abdomen.
Another surgery may be performed later to create the J-bag. A J-pouch uses part of your small intestine to form a pouch to connect to the anal canal. This creates a way for you to pass stool in the usual way through the rectum rather than through the stoma.
Treatment options for ulcerative colitis
Crohn’s disease bleeding
Blood in the stool is less common in Crohn’s disease than in ulcerative colitis. However, this may vary depending on where Crohn’s disease is causing inflammation.
Crohn’s disease can cause inflammation of the small and large intestines. Crohn’s disease found in the large intestine or rectum rather than the small intestine is more likely to cause blood in the stool.
Treatment of blood loss in Crohn’s disease is similar to that of ulcerative colitis:
- Control IBD
- vitamin supplement
- blood transfusion if necessary
- Surgery if necessary
With Crohn’s disease, excision surgery may be performed to remove the portion of the intestine that has been damaged by inflammation. J-pouch surgery is not usually used for Crohn’s disease because Crohn’s disease may reappear in the pouch.
Blood loss can also occur from anal fissures, which can be a complication of Crohn’s disease. A fissure is a tear in the lining of the anal canal. Crohn’s disease is more common with fissures than ulcerative colitis. In most cases, it can be successfully treated without surgery.
Crohn’s disease may cause blood in the stool due to inflammation or anal fissures. Severe cases of inflammation may require excision surgery to remove the damaged portion of the bowel.
Treatment options for Crohn’s disease
when to see a doctor
Tell your doctor any time you notice blood in your stool. It should be discussed with a doctor as soon as possible, especially if it has not happened for a while.
Call 911 when:
- Bleeding is severe.
- you vomited blood
- You pass out or feel like you are going to pass out.
Ulcerative colitis and Crohn’s disease are types of IBD that can cause blood in the stool. Bleeding is more common in ulcerative colitis than in Crohn’s disease.
With ulcerative colitis, you may have inflammation around your rectum, which can cause blood in your stool. Colon ulcers can also cause bleeding.
Crohn’s disease can cause inflammation of the colon or rectum causing blood in the stool. You may also bleed from an anal fissure, which can be a complication of Crohn’s disease.
Your doctor will work with you to help manage your IBD symptoms, including bleeding. Sometimes blood in the stool can lead to anemia, which is a low red blood cell count. If the bleeding is severe, you may need emergency treatment, including blood transfusions or surgery to remove the damaged bowel.
Rectal bleeding and blood in the stool or stool are not uncommon in IBD. This is one of the hallmark symptoms of ulcerative colitis, as most patients do experience it.
Even so, bleeding should always be discussed with a gastroenterologist. This may mean that something is wrong with your IBD and may require a change in treatment. It’s important to discuss it with your doctor, even if you’ve had bleeding in the past.
If you lose a lot of blood, you need immediate care. Call 911 if you have any symptoms, such as fainting, dizziness, or severe pain.
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