Sunday, May 31, 2009

Blood in stool: Part 1 Fresh Blood: Hematochezia

Bloody stools in pets can be attributable to a variety of underlying causes. While red blood in small quantities, sometimes mixed with mucous, is fairly common, it is always best to consult your veterinarian to pursue a diagnosis.
There are two variations of this problem. hematochezia and melena. Hematochezia is the presence of bright red and fresh blood in the feces, while melena is the passage of dark, tary and black feces. Melena is actually the passage of old, digested blood from bleedings which have occurred higher up in the intestinal tract. The causes, diagnostics and treatments for hematochezia often differ from those for melena. Today we will talk about heatochezia and address the ladder one in part 2 of this series.

To determine if your pet is suffering from hematochezia, here is what you should watch out for: Bright red blood in the feces, straining to defecate, an increased number of bowel movements produced, possibly no other clinical signs, possibly other systemic signs of illness, such as excessive drinking, urinating, vomiting and diarrhea, lethargy, poor appetite, weight loss
The presence of hematochezia may be a symptom of either a minor problem or a potentially more serious problem in the animal. If happening at once, hematochezia may be a minor and transient event. Repeated or persistent occurrences of hematochezia obviously are more serious and should not be ignored. There are several possible causes.

Hematochezia is often a sign of lower gastrointestinal disease. In some cases it is an indication of a minor, transient problem. In other cases it is indicative of a serious underlying disease that can become an emergency requiring intensive therapy. Hematochezia may be the only clinical sign seen, or it may be accompanied by other signs, especially straining to defecate. Obtaining a detailed history and through physical examination are essential when evaluating these patients.

The most common potential causes of hematochezia are usually associated with the gastrointestinal tract. Yet in some other cases, the cause is completely unrelated, like for example clotting disorders or coagulopathies. It is important to determine the cause of the disease as different treatments may be required.

A great number of infectious agents may result in hematochezia. They include viral infections such as panleukopenia, also called feline distemper and a contagious viral disease, bacterial infections such as Salmonella, protozoal agents such as coccidiosis (one-cell organisms living in the intestinal tracts), and intestinal parasites such as hookworms and roundworms.

Dietary intolerance and indiscretion from eating spoiled food, overeating, ingesting foreign material, supposedly especially bones, a sudden change in diet, or supposedly eating people food may cause inflammation of the lower bowel and hematochezia.

Dietary allergy to certain food substances, such as to particular proteins, lactose, high fat content, and certain food additives may also cause colon inflammation or colitis with hematochezia. Masses of the colon, rectum or anus may cause bleeding and produce hematochezia. They include benign or polyps and malignant or cancerous tumors.
Persistent hematochezia is a common sign of inflammation of the colon, sometimes also referred to as colitis. Many of the causes of hematochezia listed above also cause colitis. Colitis can also occur for unknown, immune related or poorly defined reasons and may require a colonic biopsy to identify the type of the inflammation present.

Trauma of any sort can cause hematochezia. Examples include bite wounds to the anal area, fractures of the pelvis that disrupt the colon or rectum, the passage of sharp ingested objects like for example bones, needles, tacks, etc. and the insertion of instruments or materials into the rectum like for example examination scopes, enema syringes, etc..

Bleeding disorders or coagulopathies of the body may result in bleeding from the lining of the lower bowel. There are numerous types of bleeding disorders that may occur in animals. Examples include ingestion of rat poison that contains anticoagulants, in rare cases inherited clotting disorders, even less common decreased numbers of platelets, disseminated intravascular coagulation (DIC) from massive infections or organ failure and severe liver disorders.

Intussusception or the telescoping of one part of the bowel into another secondary to foreign bodies, tumors, or parasites can cause hematochezia.

Stricture (narrowing) of the anus or colon, secondary to previous trauma, inflammation, cancer or a foreign body may result in bleeding, especially as stools are passed.

Chronic or intermittent constipation and attempted passages of dry, hard stools may result in hematochezia.

Anal sacculitis (inflammation of the anal sacs) or anal sac abscessation can change the consistency of the fluid in the anal sacs to a bloody liquid. This liquid may coat the stools as they are defecated. Anal sac diseases are uncommon with cats but more often found in dogs.

Proctitis is inflammation of the rectum and is often associated with colitis.


Obtaining a complete medical history and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the patient with hematochezia. The physical examination often includes a digital rectal examination. In addition, the following tests may be recommended: A complete blood count (CBC) to evaluate for the presence of infection, inflammation, anemia, and altered numbers of platelets. A biochemical profile to assess the overall health and function of various abdominal organs, and to help rule out other disorders. A urinalysis to evaluate the kidneys, the hydration status of the patient, and the presence of blood in the urine. Multiple fecal examinations for parasites bacteria, protozoa, and the presence of blood invisible to the bare eye . A coagulation profile to assess the ability of the blood to clot. Abdominal radiographs or x-rays to evaluate the abdominal organs and assess for the presence of a foreign body or tumor. Furthermore, your vet may recommend additional tests, based on results of the above tests and the clinical signs exhibited by the animal. These ancillary tests are selected on a case by case basis and include: An abdominal ultrasound evaluates the size, shape and texture of abdominal organs and helps to determine the presence of tumors. Organs, lymph nodes, and masses can be sampled with a needle or biopsy instrument with the guidance of ultrasound. This test may require referral of your pet to a specialist in veterinary internal medicine or veterinary radiology to perform the procedure. Bacterial fecal cultures may be recommended in those cases where a bacterial cause is suspected. Colonoscopy or a lower GI endoscopy may be of benefit in the patient with hematochezia. Colonoscopy involves the passage of a viewing scope into the lower bowel to visualize the lining of the colon and to allow biopsy of any abnormal tissue. Colonoscopy is performed under general anesthesia and may require referral of your pet to a specialist in veterinary internal medicine to perform the procedure.

As supportive care treatment of the symptoms may be necessary while diagnostic testing is underway, especially if the animal is severely ill or blood loss is dramatic. The following supportive measures may be instituted as needed to reduce the severity of symptoms or stabilize the animal. Intravenous fluid and electrolyte therapy may be indicated in severe cases of hematochezia, especially if there are concurrent systemic signs of illness like vomiting, dehydration or lack of appetite. Treatment for shock may be undertaken in weak or collapsed animals. Food and water may be withheld for 24 hours or more. Antibiotics may be started via injection.

With mild cases or nonspecific cases of hematochezia, symptomatic therapy may be tried. Typically such therapy is aimed at reducing inflammation within the lower bowel and decreasing exposure to materials that are difficult to digest or pass in the stools. Symptomatic treatments are not a replacement for specific therapy. With any serious or persistent hematochezia, it is important to perform diagnostic tests that allow a specific cause to be identified, and then specific therapy is instituted. Examples of symptomatic measures include the following: Changes in diet may be recommended and may include a trial of either a moderate or high fiber, low fat diet or a hypoallergenic diet. Thoroughly de-worming the pet is often recommended, regardless of whether the fecal examination confirms parasitism. In some cases intestinal parasites are present, but they are difficult to detect on routine fecal screenings. A broad spectrum de-wormer may be recommended. Antibiotic therapy may be recommended because these drugs alter the bacterial counts in the lower bowel and may have some mild anti-inflammatory properties. Motility modifying drugs that change the rate of movement of food through the intestines may be helpful in some cases.Once a diagnosis is made, then specific therapy may be instituted. Specific treatments are sometimes combined with supportive and symptomatic treatments to ensure the hematochezia resolves. Depending upon the cause, the following may be considered: Common treatments used for colitis include dietary changes and oral antibiotic or antibacterial like for example sulfadiazine and sulfadimethoxine medications. Corticosteroids may be indicated in some forms of immune related colitis. Treatments for clotting disorders may include Vitamin K therapy, and transfusions of either blood or plasma. Masses of the colon or rectum are surgically removed whenever possible. Intussusceptions often require correction via require abdominal surgery. The presence of colonic foreign bodies, such as bones, metallic materials, etc., may sometimes necessitate cleansing enemas or manual removal with the animal under general anesthesia. A variety of treatments exist for rectal strictures and anal sac disease.

Most of this information I found in an article written by
Dr. Bari Spielman for the What I am personally not happy about is the more in depth treatment by the vet with antibiotics and cortisone shots and similar measurements. While I am not a vet and you most certainly need to follow your vet’s advice, I personally would prefer an alternative treatment over the conventional “throw some hard core meds at the problem” solution. More natural remedies can be a great alternative for antibiotics. They are very effective and safe to use as well. Look out for homeopathic medications with powerful herbs like berberis vulgaris, cantharis, and staphysagris. These medications can treat bacterial infections like no other medication can and prevent recurring infections as well. Apart from giving the right medications make dietary changes. Highly processed food affects your pet’s health badly. The best solution is raw, unprocessed food and plenty of water to drink. And maybe you want o look for a vet fit in holistic animal care.

Note: Blood in stool: Part 2 Digested Blood: Melena

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