Blood in or on the pouch may have various causes, such as a crack in the rectum. In children, this is usually not a sign of a more serious illness.

This text is about blood in the poop in children and adolescents up to about 18 years. Blood in the adult poo may have other causes.

The blood may look different

The blood in or on poop may look different:

  • It may be light red blood streaks or small patches of blood outside the pouch, and the blood looks fresh. There may also be blood on the paper when you or the child dry themselves in the buttocks after pooping.
  • The blood may be darker and more mixed in the pouch.
  • The blood can also cause the pouch to become dark, dry, and crumbly.

When and where should I seek care?

You do not need to seek care if the baby is feeling well and the blood streaks are outside the pouch, are bright red, look fresh and go away after a couple of days. Contact a health care center if the child has blood on the pouch several times.

If you think the child has blood mixed in the poop, contact a health care center or pediatrician. Wait until it’s every day if it’s a weekend.

If it’s in a hurry

If a child has blood in the pouch and any of the following problems, contact a health care center or emergency room immediately.

  • The child is tired, unable to play or be interested in the surroundings.
  • The child has a stomach ache.
  • When the baby is pooping there will only be mucus and blood, and no poop.
  • The child has diarrhea.
  • The child has a fever.

If it is closed at the health center or on-call reception, seek care at an emergency room.

What is it?

There are several reasons why a child gets blood in the poop.

Crack in the rectum opening

One of the most common reasons is that the blood comes from a small crack or a small wound in the rectum, called an anal fissure. It may happen if the child has constipation. The blood is then fresh, light red, and is found outside the pouch.

The crack or wound can also cause some blood to come on the toilet paper after the baby has pooped.

Stomach flu

A long and intense stomach illness can cause the baby to get blood in the poop, although it is unusual. This is because the intestinal mucosa has become fragile from the infection.

The child may also have diarrhea with blood if the stomach disease was caused by the bacteria campylobacter or EHEC. 

Allergy to foods

There may be blood in the pouch if the child has food allergies to cow’s milk, for example. In cow’s milk allergy, the lining of the colon is irritated by one or more proteins in the cow’s milk. Cow’s milk allergy usually develops when the child is under one year and starts drinking or eating milk products.

Cow’s milk protein can also be developed in children who are breastfeeding, although it is unusual. The child will then react to small amounts of protein that are transferred to the breast milk if you as a breastfeeding person have eaten or drank milk products.

Food that can darken the poo

Pies can be colored by something the child has eaten. It can be beets, blueberries, or black pudding. It is easy to lose sight of the darker color of the blood bag.

The child has swollen blood

The blood may come from the baby having swollen blood and having passed through the gastrointestinal tract. Then the blood is darker and more mixed in the poop. The blood gets the dark color in the stomach’s acidic environment.

In children who are breastfeeding, the blood may come from a sore nipple. The blood can also come from the throat or from the nose, for example, if the baby has nosebleeds.

The mucous membrane of the esophagus or stomach may begin to bleed

Dark blood in the pox may be due to the child having so-called gastroesophageal reflux disease.  It is when the contents of the stomach are pushed up into the esophagus and the child gets hurt. The acidic stomach irritates the mucous membrane of the esophagus, which can start to bleed, although it is unusual.

The mucous membrane of the esophagus can also get cracks and start bleeding, for example, if the baby vomits vigorously. It is called Mallory-Weiss bleeding. 

The mucous membrane of the stomach can also become irritated during gastric and gastric ulcers.

Congenital extra pocket in the intestine

Children can sometimes be born with an outgrowth similar to a pocket in the small intestine, although it is unusual. Such growth is called Meckel’s verticle. The child does not always get symptoms, but it may happen that a wound is formed inside the pocket that is bleeding. It can also cause inflammation inside the pocket that hurts.

intussusception

An unusual cause is a so-called invagination. It is a type of gut where one part of the intestine has crept into the next part of the intestine. Other symptoms of invagination are that the baby has a lot of stomach ache and that it hurts in periods, so-called intervals.

Inflammatory bowel disease

Children can get blood in the pouch if they have ulcerative colitis or Crohns disease. Both are so-called inflammatory bowel diseases. In both diseases, the child also has stomach pain and diarrhea.

bleeding disorders

Henoch-Schönlein’s purpura and idiopathic thrombocytopenic purpura are two examples of unusual bleeding disorders that can cause blood in the poo.

Enoch-Schönlein purple

Symptoms of Henoch-Schönlein’s purple are that the child gets dark red or purple rashes that look like small bruises. The rash spreads over the child’s legs, buttocks and arms. The baby’s joints can swell and hurt. The baby also gets stomach aches. This is because the intestinal mucosa is inflamed. The disease often starts in conjunction with a common cold.

Idiopathic thrombocytopenic purpura, ITP

In the idiopathic thrombocytopenic purpura, the child bleeds easily, for example, they can often get nosebleeds, bruises, and bleeding wounds. It also takes a long time for the wounds to stop bleeding. This is because the disease reduces the number of platelets that usually stop bleeding. Idiopathic thrombocytopenic purpura is also called primary immunologic thrombocytopenia.

There are two forms of the disease, one acute and one chronic. Children usually get the acute form. It goes away within six months and usually the child does not need treatment. The chronic form is more common in adults.

Read more about platelets in the text Blood and the immune system.

Investigations

When you see a doctor, you and the child will tell you what happened and what the poop looks like. The doctor senses the baby’s stomach and looks into the rectum. It is to see if the child has cracks, wounds or signs of inflammation in the rectum.

The child may be given a sample on the poop, so-called stool sample. The test shows if there is blood in the poop that is not visible. Sometimes the child also needs to pass stool samples to see if there are bacteria in the poop.

Depending on what the stool samples show, the child may need to undergo other examinations.

Children should also be involved in their care

There is no age limit when a child is allowed to participate in a care situation. The child’s right to decide for himself is related to the child’s maturity. The older the child, the more important it is for them to be involved in their care.

It is important that you understand the information you receive from the healthcare staff in order to be active in the care and make decisions. Ask questions if you don’t understand. You can also ask to have the information printed to read it peacefully.

If interpretation is needed in other languages, you may have the right to have it. You may also have the right to receive interpreting assistance in the event of hearing loss.

Muhammad Nadeem

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