Gastrointestinal Bleeding

Overview

Gastrointestinal bleeding means bleeding somewhere along your digestive tract. The digestive tract is the long tube that runs from your food pipe (oesophagus), through your stomach and bowel, down to your back passage (anus). The bleeding can be obvious — you may see blood in your vomit or in your stool (poo) — or it can be hidden, meaning there is only a small amount of blood that a test can pick up. Where the bleeding comes from matters. Doctors talk about 'upper' bleeding (from the food pipe, stomach or the first part of the bowel) and 'lower' bleeding (from the large bowel, back passage or anus). Both are treated in similar ways at first: find the cause, stop the bleeding, and replace any blood you have lost.

Yes, it is common. Bleeding in the gut is one of the more frequent reasons people are admitted to hospital as an emergency, and mild bleeding — especially small amounts of bright red blood from piles or a small tear — is very common in everyday general practice.

Anyone can be affected, at any age. It is more common in older adults, and in people who take painkillers of the anti-inflammatory type, blood-thinning medicines, or who have liver disease, a stomach ulcer, inflammation of the bowel, or a history of heavy alcohol use. Children can get it too, most often from small tears or constipation, and occasionally from swallowed blood after a nosebleed.

Symptoms

Common symptoms

• Black, sticky, tar-like stool (doctors call this melaena) — this usually means blood has been digested higher up in the gut
• Bright red blood on the toilet paper, in the toilet bowl, or streaked on the stool
• Vomiting blood, or vomiting material that looks like dark coffee grounds
• Feeling dizzy, light-headed or weak, especially when standing up
• Tiredness, breathlessness or looking pale (signs of low iron or anaemia)
• Tummy (abdominal) pain, indigestion or nausea
• A racing heart or feeling unusually cold and clammy

Symptoms in children

• Streaks of bright red blood on the stool or toilet paper — often a small tear from constipation
• Blood mixed into the stool, which can happen with a tummy infection (gastroenteritis) or a food allergy such as a milk allergy in babies
• Bloody vomit, which may come from swallowed blood after a nosebleed or from a chest infection with a lot of coughing
• Tummy pain, clinging behaviour, or a baby who is feeding poorly or seems in pain
• Pale skin, low energy, or not passing much urine — signs of losing fluid or blood

Symptoms in older adults

• Confusion or sudden worsening of memory problems, which can be the first sign of blood loss in older people
• Feeling very tired, weak, or unsteady on the feet, sometimes with a fall
• Breathlessness or chest discomfort caused by anaemia (low red blood cells) rather than by the gut itself
• Black stools that are easy to miss, especially if you do not look closely at the toilet
• Dizziness when standing up, or a faster heartbeat than usual

Causes

Main causes

• Stomach or duodenal ulcers — open sores in the lining of the stomach or the first part of the bowel
• Inflammation of the stomach lining (gastritis) or of the food pipe (oesophagitis), often from acid reflux
• Enlarged, fragile veins in the food pipe or stomach (varices), usually caused by liver disease
• A tear in the lining of the food pipe after forceful vomiting or retching (sometimes called a Mallory-Weiss tear)
• Piles (haemorrhoids) or a small tear in the skin near the back passage (anal fissure) — very common causes of bright red blood
• Small growths on the bowel wall (polyps) or, less often, bowel cancer
• Inflammatory bowel disease, such as ulcerative colitis or Crohn's disease
• Pockets in the bowel wall (diverticular disease) that can bleed
• Fragile, widened blood vessels in the bowel lining (angiodysplasia), more common with age
• Blood-thinning medicines, anti-inflammatory painkillers, or heavy alcohol use irritating or damaging the gut lining

Risk factors

• Taking anti-inflammatory painkillers regularly, or blood-thinning medicines
• A previous stomach ulcer, or infection with the bug that causes ulcers (Helicobacter pylori)
• Liver disease or scarring of the liver (cirrhosis)
• Heavy or long-term alcohol use
• Smoking
• Older age
• Inflammatory bowel disease
• A family history of bowel cancer or bowel polyps
• Long-standing constipation, which makes piles and small tears more likely

When to see a doctor

See a doctor urgently if:

• You have vomited any blood or coffee-ground material
• You have black, tar-like stools
• You have blood in your stool along with feeling dizzy, weak or faint
• You have ongoing tummy pain, fever, or you cannot keep fluids down
• You are taking blood thinners and notice any bleeding

Book a routine appointment if:

• You have noticed a small amount of bright red blood on the toilet paper or in the bowl more than once
• Your stools are darker than usual and you are not sure why
• You feel unusually tired or breathless, or a blood test has shown low iron
• There has been an unexplained change in your bowel habits lasting more than a few weeks
• You have piles that keep bleeding or are uncomfortable

Diagnosis

Your doctor will start by asking what you have noticed — the colour and amount of blood, how long it has been happening, any pain, your medicines, and your general health. They will examine you, which may include feeling your tummy and checking your back passage with a gloved finger. Blood tests can show whether you have lost blood or have low iron. The next step is usually a camera test to look directly at the lining of your gut and, if needed, to treat the bleeding at the same time.

Tests that may be done

• Blood tests, including a full blood count to check for anaemia and tests of liver and kidney function
• A stool test, which can check for hidden blood or for inflammation
• Gastroscopy (also called an endoscopy) — a thin, flexible tube with a camera passed through the mouth to look at the food pipe, stomach and first part of the bowel
• Colonoscopy or flexible sigmoidoscopy — a camera test passed through the back passage to look at the lower bowel
• CT scan, sometimes with a dye, to look for the source of bleeding or for problems in the bowel wall
• Capsule endoscopy — you swallow a tiny camera in a capsule that takes pictures as it travels through the small bowel
• An angiogram, a scan of the blood vessels, used in some cases of heavy or hard-to-find bleeding

What to expect at your appointment

Many of these tests are quick, and most people are given a sedative or a light anaesthetic to keep them comfortable. You will usually be asked not to eat for a few hours beforehand, and you will need someone to take you home afterwards if you have sedation. Results are often known the same day for camera tests, while blood and stool tests may take a few days. Your doctor will explain what was found and what happens next.

Treatment

Treatment depends on where the bleeding is coming from and how heavy it is. The first aim is always to make you safe — stopping serious bleeding, replacing lost fluid or blood if needed, and checking whether any of your medicines are making the bleeding worse. After that, the focus shifts to treating the cause so the bleeding does not come back.

Self-care at home

• Do not take anti-inflammatory painkillers without checking with your doctor or pharmacist first — ask what is a safer option for you
• Never stop or change a prescribed blood thinner on your own; phone your doctor or the team who prescribed it for advice
• Avoid alcohol while you are recovering, as it irritates the stomach lining and can make bleeding more likely
• Eat gentle, regular meals rather than large or very spicy ones if your stomach feels sore
• Drink plenty of fluids, and eat iron-rich foods such as beans, lentils, leafy greens and lean meat if you have been told you are low in iron
• Keep a simple note of any bleeding you notice — colour, amount and when it happened — so you can tell your doctor
• Take any prescribed iron or acid-reducing medicine as directed, and ask your pharmacist if it upsets your stomach

Medical treatments

Doctors can often stop bleeding during a camera test, using tiny clips, heat, or injections to seal the bleeding point. Medicines that reduce stomach acid help ulcers heal, and if a test finds the bug that causes ulcers, it is treated with a short course of antibiotics. If you have lost a lot of blood, you may be given fluids through a drip or a blood transfusion. Treatment for inflamed veins caused by liver disease is done by specialists and may include medicines to lower pressure in those veins. Iron tablets or, sometimes, iron through a drip can help rebuild your blood count. Your doctor will also review any medicines that might have contributed to the bleeding.

When is surgery considered?

Surgery is needed only in a minority of cases. It may be considered if bleeding cannot be controlled during a camera test, if there is a hole or tear in the bowel, if a section of bowel needs to be removed because of cancer or severe disease, or if bleeding keeps coming back and other treatments have not worked. Your specialist team would discuss this with you carefully beforehand.

Living with this condition

Most people recover well and get back to normal life. In the first few weeks you may feel more tired than usual, especially if you lost blood, and it can take a little time for your energy and blood count to build back up. Keep taking any medicines you have been given, go to follow-up appointments, and tell your doctor if you notice bleeding again or feel unwell.

Lifestyle tips

• Cut down or stop smoking — it slows healing and raises the risk of ulcers and bowel problems
• Reduce or avoid alcohol, particularly if you have liver disease
• Eat regular meals and include fibre-rich foods to keep your bowels moving and prevent constipation
• Drink enough water through the day
• Stay active with gentle exercise such as walking, building up as you feel stronger
• Ask your pharmacist to review your medicines, including anything you buy over the counter
• Keep a note of any new symptoms so you can raise them at your next appointment

Diet and exercise

There is no single 'gut bleeding diet', but gentle, balanced eating helps. Aim for regular meals with plenty of vegetables, fruit, whole grains, beans and lean protein, and go easy on very spicy, fatty or acidic foods if they upset your stomach. Fibre and fluids help prevent constipation, which protects against piles and small tears. Once you feel well enough, gentle exercise such as walking or swimming supports healing and overall health — build up gradually rather than all at once.

Mental health and emotional wellbeing

It is very normal to feel anxious after seeing blood, and some people worry about it happening again or feel shaken after a hospital visit. Sleep, appetite and mood can all be affected for a while. These feelings usually settle as you recover, but if worry is lingering, affecting your sleep, or making you avoid going out, please talk to your doctor — support is available and there is no need to cope alone. If you ever feel you cannot keep yourself safe, contact your local emergency number or a crisis support service in your country straight away.

Prevention

Not all bleeding can be prevented, but you can lower your risk. The most useful steps are to use anti-inflammatory painkillers only when needed and with advice, to take blood thinners exactly as prescribed, to limit alcohol, to stop smoking, and to get ongoing stomach pain, heartburn or changes in bowel habits checked rather than ignoring them.

Screening programmes

Bowel cancer screening programmes invite adults in mid-to-later life to send a simple stool sample for hidden blood testing, and some countries also offer a one-off camera test. Screening finds problems early, often before any symptoms appear. Ask your doctor or local health service when you are due, and always take part if you are invited. If you have a strong family history of bowel cancer or polyps, tell your doctor, as you may be offered earlier checks.

Complications

If left untreated

• Anaemia (low red blood cells), causing tiredness, breathlessness and pale skin
• A large drop in blood pressure from heavy blood loss, which can lead to shock
• A hole or tear in the bowel wall, which is serious and needs urgent treatment
• Scarring and narrowing of the bowel after healing, which can cause pain or blockages
• The underlying cause going undiagnosed — for example an ulcer, inflamed bowel or, in a small number of cases, bowel cancer

Long-term outlook

The outlook is good for most people. Piles, small tears and many ulcers settle with simple treatment, and even serious bleeding is usually controlled quickly in hospital. Finding the cause early makes a real difference, which is why it is worth getting checked even when bleeding seems minor. Most people recover fully and return to normal life — and if something more serious is found, being diagnosed early gives the best chance of successful treatment.

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