Patients may have a history of hemorrhoids, diverticulosis, inflammatory bowel disease, peptic ulcer, gastritis, cirrhosis, or esophageal varices. Sticky, black, foul-smelling stools suggest a source proximal to the ligament of Treitz, but it can also result from bleeding in the small intestine or proximal colon. Malignancy may be indicated by a change in stool caliber, anorexia, weight loss and malaise. Associated Findings Abdominal pain may result from ischemic bowel, inflammatory bowel disease, or a ruptured aortic aneurysm. Painless, massive bleeding suggests vascular bleeding from diverticula, angiodysplasia or hemorrhoids.
Bloody diarrhea suggests inflammatory bowel disease or an infectious origin.
Bleeding with rectal pain is seen with anal fissures, hemorrhoids, and rectal ulcers. Chronic constipation suggests hemorrhoidal bleeding. New onset constipation or thin stools suggests a left-sided colonic malignancy. Blood on the toilet paper or dripping into the toilet water after a bowel movement suggests a perianal source. Blood coating the outside of stool suggests a lesion in the anal canal.