Stools - Blood In

Is this your child's symptom?

  • Blood in or on the stool
  • Blood can also be 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.
  • Cow's Milk Colitis. Starts within the first 2 months of life. Causes loose, slimy stools. Can be blood-streaked. Treatment: need to avoid cow's milk formulas.
  • 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.

Causes of Red Stools, 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)

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.

When to Call for Stools - Blood In

Call 911 Now

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

Call Doctor or Seek Care Now

  • 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 less than 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

Contact Doctor Within 24 Hours

  • Small amount of blood in the stools. 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.

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

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 health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.