Occult blood in the stool may not be visible to the eye but can be detected in a fecal occult blood test (FOBT), also called stool occult test or hemoccult test. However, the test is not diagnostic because it cannot identify the cause or site of the bleeding. Instead, a positive FOBT result indicates the need for further investigation through a colonoscopy, endoscopy, barium swallow, CT scan, MRI scan, and other tests.
Treatment of occult blood in the stool depends on the underlying cause. Blood in the stool indicates bleeding in the digestive tract, which could be an indication of polyps, tumors, or cancer in the colon or rectum. Conditions that can be screened through FOBT irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD).
A FOBT can be done in an inpatient or outpatient setting:
- Inpatient: Stool sample is taken via a digital rectal examination and sent for lab analysis.
- Outpatient: Stool sample is collected at home by the patient and sent to a lab for evaluation.
If you are at risk for gastrointestinal cancers, you may require annual fecal occult blood testing. Other risk factors include obesity, tobacco usage, and excessive alcohol consumption.
9 causes and treatment of occult blood in stool
1. Anal fissure
- Definition: Minor rip that occurs when anal tissue is stretched when straining during a hard bowel movement, resulting in rectal bleeding and extreme pain.
- Treatment: Anal fissures typically resolve on their own within 4-6 weeks. Treatment may include dietary fiber and stool softeners, as well as lotions applied to the afflicted area.
2. Crohn's disease
- Definition: A type of chronic inflammatory bowel disease that causes abdominal pain, severe diarrhea, exhaustion, weight loss, and rectal bleeding due to inflammation in the digestive tract.
- Treatment: Crohn's is incurable. To slow the progression of illness, however, dietary modifications and medications such as steroids and immunosuppressants may be recommended. If these measures do not work, surgery may be necessary. Patients with Crohn's disease may require routine colorectal cancer screening due to an elevated risk.
3. Diverticular disease
- Definition: Diverticula are small pockets that form and push through weak places in the colon wall, caused by straining during bowel movements. Diverticulitis occurs when the pockets become infected or inflamed, causing nausea, vomiting, and rectal bleeding.
- Treatment: Antibiotics can be used to treat diverticulitis symptoms. If complications develop or if other treatment options fail and the condition is severe, surgery may be required.
4. Colonic polyps
- Definition: Colonic polyps, also called colorectal polyps, are growths on the inside of the large intestine and can cause rectal bleeding. Colon polyps can be classified into three types.
- Hyperplastic polyps: Typically harmless
- Adenomatous polyps: Most common and can lead to colon cancer if left untreated
- Malignant polyps: Contain cancer cells
- Treatment: Polypectomy may be required, which involves removing the polyps using forceps or a wire loop during a colonoscopy or flexible sigmoidoscopy. The polyps are then examined to check for cancer.
- Definition: Hemorrhoids, also called piles, are one of the most common causes of occult blood in the stool and are caused by enlarged veins in the rectum and anus. Intestinal infections (salmonella, enteroinvasive and enterohemorrhagic Escherichia coli, shigella, Neisseria, Yersinia, tuberculosis, campylobacter, and Strongyloides) can also cause inflammation of the mucus lining and lead to hemorrhoids.
- Treatment: Eating a high-fiber diet and taking stool softeners can help. Surgery to remove hemorrhoids may be required in some cases..
6. Meckel's diverticulum
- Definition: Congenital defect that causes a small protrusion in the gastrointestinal tract, Patients may experience fever, diarrhea, and blood in the stool as a result of diverticula inflammation caused by obstructed feces.
- Treatment: Treatment is not required if there are no symptoms. If symptoms do develop, surgery may be required to remove the diverticulum and repair the intestines.
7. Vascular (blood vessel) conditions
- Definition: Problems with the blood vessels in the gastrointestinal tract, such as blood vessel abnormalities and blood vessel disease. Angiodysplasia, venous ectasia, variceal hemorrhage, hemangioma, and gastric antral vascular ectasia are examples of vascular conditions.
- Treatment: Several nonoperative therapies are available, such as pharmacotherapy, intravascular embolization, endoscopic sclerotherapy, or banding. However, in cases of significant bleeding, surgical resection may be required.
8. Ulcerative colitis
- Definition: Inflammatory disorder in the colon that causes discomfort and open sores. The inflammation usually starts in the rectum and progresses upward. Symptoms include diarrhea, weight loss, abdominal discomfort, anemia, and blood or pus in the stool.
- Treatment: Drug therapy or surgery are frequently used to treat ulcerative colitis, along with diet and lifestyle modifications.
- Definition: Sores that occur in the stomach, small intestine, or esophagus lining that can sometimes result in rectal bleeding.
- Treatment: Treatment may include medication to reduce stomach acid production. Antibiotics may be required if the infection is caused by bacteria. Surgery is required if the ulcer is perforated.
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Högberg C, Samuelsson E, Lilja M, Fhärm E. Could it be colorectal cancer? General practitioners' use of the faecal occult blood test and decision making--a qualitative study. BMC Fam Pract. 2015 Oct 26;16:153. https://www.medscape.com/viewarticle/854083_2
Medline Plus. Fecal Occult Blood Test (FOBT). https://medlineplus.gov/lab-tests/fecal-occult-blood-test-fobt/
Kaur K, Adamski JJ. Fecal Occult Blood Test. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK537138/
American Society of Clinical Oncology. Fecal Occult Blood Tests. https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/fecal-occult-blood-tests
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