Is this your child’s symptom

• Blood-colored material mixed in the stool, on the surface or passed alone
• Blood in the stools is mostly bright red
• Blood from bleeding in the stomach comes out tar-black
• Included: Blood from constipation and anal fissure tear

Causes of Blood in Stool

• Anal Fissure. If no diarrhea, most of these children have a small tear in the anus. This is called an anal fissure. Anal fissures usually are caused by passage of a large or hard stool. This is the cause in 90% of children with blood in the stools.
• Strep Skin Infection. A Strep skin infection around the anus can also cause blood-streaked stools.
• Bacterial Diarrhea. If also has bloody diarrhea, a gut bacterial infection may be the cause. Examples are Shigella, Salmonella, E.Coli 0157 or Campylobacter.
• Red, but not Blood. The things listed below can also cause red-colored stools that look like blood:
• Certain foods such as tomatoes or beets
• Certain drinks such as red Kool-Aid
• Certain medicines such as amoxicillin or omnicef
• Amount. Blood spreads rapidly and widely in water. Passing a stool with a few blood streaks often turns the toilet water pink. It doesn’t mean a large blood loss.

Anal Fissure or Tear

• An anal fissure is the most common cause of blood in the stools.
• It causes blood on the surface of a stool. Blood may also be found on toilet tissue after wiping.
• The blood is always bright red.
• Only a few streaks or flecks are seen.
• You may see a shallow tear at 6 or 12 o’clock on the anus.
• Caused by passing a large or hard stool.

Call 911 Now

• Passed out fainted or too weak to stand
• You think your child has a life-threatening emergency

Call Doctor Now or Go to ER

• Tarry or black-colored stool not dark green
• Blood with diarrhea
• Pink- or tea-colored urine
• Stomach pain or crying also present
• Skin bruises not caused by an injury
• Age under 12 weeks
• After an injury to anus or rectum
• High-risk child such as with bleeding disorder or Crohn’s disease
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

• Blood in the stools, but none of the symptoms above. Reason: Most likely an anal fissure or tear. This needs a doctor’s input.
• Note: Try to save a sample of the "blood" for testing.

Care Advice for Anal Fissure

1. What You Should Know About Anal Fissures:
   • An anal tear is the most common cause of blood in the stools.
   • This is called an anal fissure.
   • It causes blood on the surface of a stool.
   • Blood may also be found on toilet tissue after wiping.
   • It is caused by passing a hard or large stool.
   • Here is some care advice that should help until you talk with your doctor.
2. Warm Saline Baths:
   • Give a warm salt water bath for 20 minutes.
   • Add 2 ounces 60 ml of table salt to a tub of warm water. You can also use baking soda.
   • Do 2 times per day for 1 day to cleanse the area and to help healing.
3. Steroid Ointment:
   • If the anus seems red, use 1% hydrocortisone ointment such as Cortaid. No prescription is needed.
   • Put a little around the anus.
   • Use 2 times per day for 1 day to help healing.
4. High-Fiber Diet:
   • For children more than 1 year old, change the diet.
   • Increase fruits, vegetables and grains fiber.
   • Reduce milk products to 3 servings per day.
   • If Constipation is the cause, see that care guide.
5. What to Expect:
   • Most often, anal tears heal up quickly with home treatment.
6. Call Your Doctor If:
   • Bleeding gets worse
   • Small bleeding occurs more than 2 times
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Copyright 1994-2015 Barton D. Schmitt, MD. All rights reserved.