Blood in the stool
Blood in the stool can have different forms. Sometimes there is a small amount of bright red blood on the toilet paper or on the outside of the stool. The blood may also be mixed by the stools. Black, tarlike stools may indicate blood that has come from the gastrointestinal tract higher and has changed during digestion.
The cause may be relatively innocent, for example a hemorrhoid or anal fissure, but blood loss may also occur in inflammation, gastric or intestinal ulcers, polyps and other gastrointestinal disorders. Therefore, it is important that unexplained or recurrent blood loss is medically assessed.
Within Chinese medicine, not only the blood loss itself is looked at. Also the colour and amount of blood, stool, possible abdominal pain and other complaints help determine which underlying TCM pattern is present.
Possible western causes
Blood in or with the stool may occur, among other things:
- haemorrhoids
- anal fissures
- diverticula
- intestinal infections
- inflammatory bowel diseases such as Crohn's disease and ulcerative colitis
- Gastrointestinal ulcers
- gastritis
- polyps
- disorders of blood vessels in the gut
- tumors of the stomach or gut
- Blood clotting disorders
Certain medicines, including anti-inflammatory painkillers (NSAIDs), aspirin and anticoagulants, may also increase the risk of bleeding in the gastrointestinal tract.
Black stools do not always have to be caused by blood. Among other things iron supplements and certain foods can darken the stools.
When medical assessment is important
Blood loss from the gastrointestinal tract may be serious in some situations. Therefore, Chinese medicine is not intended to replace medical diagnostics in case of unexplained blood loss.
Let blood in the stool be evaluated by a doctor, especially if it occurs for the first time, comes back regularly or is present without any clear explanation.
Rapid medical assessment is necessary in case of high blood loss, black tar-like stools, blood vomiting, severe abdominal pain, fainting, pronounced dizziness or rapid decline.
If the cause is known and treatment with Chinese medicine is appropriate, acupuncture or Chinese herbal medicine may be used in addition.
Possible causes
The cause largely determines what the blood loss looks like.
Bright red blood often occurs low in the gastrointestinal tract, for example from the anus, rectum or colon. For haemorrhoids or fissure the blood is often on the toilet paper or on the outside of the stools.
Blood that comes higher from the digestive tract has longer contact with stomach acid and digestive juices. This can make the stool very dark or black and tarry.
In addition to local abnormalities, inflammation, damage to the mucous membrane, vascular problems and problems with blood clotting can cause blood loss. In case of chronic or recurrent blood loss, anaemia may eventually occur.
What can acupuncture do?
When medically it is clear where the blood loss comes from and acupuncture can be applied responsibly, the treatment is adjusted to the overall picture of complaints.
Within Chinese medicine, for example, a distinction is made between blood loss associated with Heat or inflammatory symptoms, stagnation of circulation or weakened digestion.
Depending on the pattern, treatment may be directed at:
- reduction of heat when blood loss coincides with burning, thirst or other heat phenomena;
- reduction of Dampness-Heat for example in diarrhoea, mucus, heavy feeling or burning around the anus;
- Improving the circulation of Qi and Blood when stagnation and pain are at the forefront;
- Intensifying the Spleen-Qi when prolonged weakness and a tendency for blood loss coincide;
- ... to support digestion in chronic abdominal and stool problems.
In case of severe or acute blood loss, regular medical treatment takes precedence.
What can Chinese herbal medicine do?
Chinese herbs are also chosen based on the underlying pattern. Therefore, there is no single standard herbal treatment for blood in the stool.
For example, in clear Heat, other herbs are used than in weakened Spleen-Qi or Spleen-Yang. When blood loss is associated with Blood stasis, the emphasis is on restoring circulation. Additional complaints such as abdominal pain, diarrhoea, constipation, reflux, fatigue and a cold or warm feeling are also taken into account.
The treatment may include:
- a cooling excessive heat and reducing blood loss;
- The removal of Dampness-Heat from Stomach and Intestines;
- regulation of the circulation of Qi and Blood;
- strengthening the Spleen so that, according to the TCM, it can better perform its function of the Spleen inside the barrels.
- feeding Yin when prolonged dryness and heat have weakened the mucous membrane.
In case of blood loss, it is especially important that herbs are tuned to both the cause and any medication used, including anticoagulants.
How does Chinese medicine view blood in the stool?
Western medicine initially tries to determine where the blood comes from and what condition it causes. That is essential in blood in the stool.
Chinese medicine also looks at the pattern in which blood loss occurs. Among other things, Stomach, Intestines, Spleen and Liver are important.
In Heat, blood can move too strongly according to the TCM, making it easier to get out of the blood vessels. At Dampness-Heat heat phenomena go together with accumulation of fluid and waste in the digestive system. Blood stasis disturbs the normal circulation of Blood. If there is a shortage of Spleen-Qi, it lacks sufficient strength to keep the Blood well within the blood vessels.
Also long-term illness or blood loss can eventually lead to shortages of Qi, Blood, Yin or Yang.
A recognizable combination of such signs and symptoms is called a TCM pattern.
Below are the most common patterns. Other patterns are possible and multiple patterns may occur at the same time. Therefore, you don't need to have all the symptoms mentioned in one pattern and you can recognize yourself in different patterns. The pattern is determined by the overall picture of complaints.
Most common TCM patterns
Heat in Stomach and Intestines
With this pattern, according to the TCM, there is too much heat in the digestive system. This Heat can affect the blood vessels and make it easier for Blood to come out.
Common symptoms:
- red to dark blood;
- burning or painful abdominal discomfort;
- acid reflux or heartburn;
- dry mouth and thirst;
- constipation or dry stools;
- a warm feeling;
- sometimes irritability.
When especially the Stomach is involved, stomach pain, strong thirst, bad breath and heartburn may become more noticeable.
Examples of Western disorders: gastritis, gastrointestinal ulcers, reflux oesophagitis and certain inflammatory processes of the gastrointestinal tract.
Liver-Heat that the Stomach disturbs
According to the TCM, emotional tension and prolonged stagnation of Liver-Qi can eventually cause Heat. This Heat can affect the Stomach and disrupt the normal circulation of Blood.
Common symptoms:
- bleeding from the gastrointestinal tract;
- stomach or upper abdominal pain;
- symptoms that worsen with stress;
- pain or tension under the ribs;
- irritability;
- headache;
- acid reflux or heartburn;
- thirst or dry mouth.
This pattern is particularly relevant when gastrointestinal symptoms are clearly associated with stress, frustration or emotional tension.
Examples of Western disorders: gastritis, reflux symptoms and gastric or intestinal ulcers in which stress plays a clear role.
Dampness-Heat in the Intestines
According to the TCM, two processes come together at Dampness-Heat: accumulation of moisture and excess heat. This often results in a combination of blood loss, mucus, abnormal stool and a heavy or burning sensation.
Common symptoms:
- red, dark red or purple-like blood;
- blood mixed with the stool;
- mucus at the stool;
- diarrhoea or sticky, hard-to-remove stool;
- strong smelling stool;
- abdominal pain or bloating;
- urge where after the stool remains the feeling that the bowel is not completely empty;
- burning or pain around the anus.
Examples of Western disorders: infectious colitis, inflammatory bowel diseases and some types of chronic bowel inflammation.
Blood stasis
Blood stasis means within Chinese medicine that the normal circulation of Blood is locally disturbed. This pattern usually occurs with longer existing symptoms and often coincides with clearly localized pain.
Common symptoms:
- dark red, purple or solidified blood;
- blood mixed with the stool;
- sometimes black, tarry stools;
- fixed or stabbing abdominal pain;
- pain clearly situated in one place;
- sometimes a palpable hardening or mass;
- long-term or recurring complaints.
Blood stasis can be associated with other patterns, such as Heat, Cold or Qi deficiency.
Examples of Western disorders: chronic gastric or intestinal ulcers, divertic diseases, polyps and other chronic conditions involving local tissue or blood vessels.
Spleen-Qi-deficiency
Within the TCM, not only does the Spleen help with digestion, it also has the function of keeping the Blood within the blood vessels. If the Spleen-Qi is weakened for a long time, chronic or recurrent blood loss can occur more easily.
Common symptoms:
- small amounts of returning blood;
- often dark or dull coloured blood;
- loose or poorly formed stools;
- fatigue;
- paleness;
- low appetite;
- bloating;
- quickly full;
- dizziness or light-headedness;
- palpitations during exercise.
Long-term blood loss can also lead to a shortage of Blood, which further increases fatigue and paleness.
Examples of Western disorders: chronic gastrointestinal problems with low blood loss, some polyps and conditions where chronic blood loss or anaemia occurs.
Spleen- and Stomach-Yang-deficiency
This is a more advanced form of weakness where, in addition to insufficient Qi, there is insufficient heating power. The complaints are therefore often chronic and clearly go together with Cold.
Common symptoms:
- recurrent low blood loss;
- bleach or dark blood;
- loose stools;
- dull abdominal pain;
- abdominal pain which improves by heat and pressure;
- cold hands and feet;
- being rapidly cold;
- low appetite;
- pronounced fatigue and weakness.
Examples of Western disorders: long-term gastrointestinal disorders where chronic blood loss is associated with diarrhoea, decreased appetite and general weakening.
Stomach-Yin-deficiency with Heat
Yin stands within the TCM for, among other things, the nourishing and moistening aspects of the body. When the Yin of Stomach becomes weakened for a long time, dryness occurs and at the same time so-called deficiency heat can occur.
This pattern occurs especially in long-term complaints and may occur after other forms of Heat have burdened the body for a longer period of time.
Common symptoms:
- recurrent blood loss;
- black, dry stools or constipation;
- prolonged nagging or burning stomach discomfort;
- dry mouth and thirst;
- dry skin or mucous membranes;
- feeling warm in the afternoon or evening;
- night sweats;
- irritability or insomnia.
Examples of Western disorders: chronic gastritis, chronic gastric ulcers, reflux oesophagitis and other long-term upper gastrointestinal disorders.
Outlook
The prognosis depends entirely on the cause of blood loss. A small amount of bright red blood from a known anal fissure or hemorrhoid requires a very different approach than blood loss due to inflammation, gastric ulcer or other gastrointestinal disease.
Therefore, in case of unexplained blood loss a good medical diagnosis is first central. When additional treatment with acupuncture or Chinese herbs is appropriate, the course of treatment depends, among other things, on the cause, duration and amount of blood loss, the underlying TCM pattern and general health.
Acute or severe bleeding is not part of a regular acupuncture or herbal pathway and requires medical assessment.
Contact
If you have blood in the stool and the cause has been medically investigated, it can be examined during an intake whether acupuncture and/or Chinese herbal medicine can fit with your symptoms.
The treatment is tailored to the cause of the complaints, any regular treatment and the underlying pattern according to Chinese medicine.
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