Is it normal to have blood in your stools? Blood in the stools is never normal. If the stool has blood in it, it is either from a bleeding from a ripped mucosa (lining) of the rectum (from passing very hard stools when constipated), or from a bleeding polyp, a more serious condition, or even cancer. Traces of occult blood (not obvious to the naked eye) may be from taking iron pills or red meat; or, raw fruits and vegetables, vitamin C or aspirin (which causes blood thinning and some micro bleeding in the guts in some people). Women who are menstruating when the stool sample is taken may have either frank red blood or traces of blood in the stools.

Why be concerned about it?

          As we have alluded to above, blood in the stools could be a sign of a serious illness in the gut, like cancer.

What test could be done to find out?

            The diagnostic procedure is called fecal occult blood test (FOBT), a non-invasive way of detecting the presence of occult (hidden or not obvious to the naked eye) blood in the feces. There are two popular tests: Guaiac Smear Test, available from hospital outpatient laboratory or the doctor’s office and interpreted by a medical practitioner; and the InSure test. This is done as a screening test, and should be done even if there are no symptoms, as a prophylaxis measure.

Who should be tested?

          For people age 50 and older, the American Cancer Society recommends the FOBT be performed every year. The test is done earlier than 50 (also once a year) if the person has any of the following: a family history of colorectal cancer or polyps or hereditary colorectal cancer syndrome; or a personal history of colorectal or adenomatous polyps or chronic inflammatory bowel disease. The test does not carry any risk.

How accurate is the FOBT?

            Fecal Occult Blood Test is very accurate when it comes to detecting occult blood in the stools, although there could be false positive results (where the test shows positive result but there is no active bleeding present). According to an Australian study, the relative sensitivity for detecting cancer was 39% for the Hemoccult test and 85% for the InSure test. For  cancers and advanced adenomas combined, the sensitivity was 50% for the Hemoccult test and 77% for InSure. Both tests had a false-positive rate of about 4%.

What’s this newest test for occult blood?

          The “new” fecal test for occult blood is called InSure (manufactured by Enterix), an immunochemical technology that is superior to the standard Guaiac (Hemoccult) test for screening tool for colorectal cancer, according to Sheillah C. Gentile, M.D., of Munster, Indiana, formerly with the research section of Boehringer-Ingelheim of Germany. InSure was released in 2003 but somehow barely hitting the medical market the past few months. It is much more sensitive and more specific in diagnosing colorectal malignancy. Also, with InSure, the stool sample is taken by swirling a brush (that comes with the kit) around water in the toilet bowl after defecation, unlike Hemoccult which requires collection of stools on a sheet of tissue provided, from which the specimen is taken, which people consider “gross” and messier. With InSure, only 2 stool samples are needed, versus the Hemoccult, which requires 3 samples. But more importantly, with InSure, one does not need dietary and medication restrictions, as with the guaiac Hemmoccult. It is certainly the new preferred, and more convenient and more specific, test for occult blood.

What are the signs/symptoms of colorectal cancer?

          Unexplained weight loss, change in bowel habits, diarrhea, constipation or sensation that the bowel does not empty completely, stools appears flat or narrower than usual, bright red blood or black stools, frequent bloating, fullness, cramps or gas pains, persistent fatigue, anemia, vomiting. By the time any of these signs and symptoms are obvious, the stage of the cancer might be advanced. This is why the preventive screening tests are essential.

How much role does prevention play?

            In colorectal cancer, just like in many forms of cancers, prevention plays a vital role. A healthy lifestyle, including daily exercises, abstinence from cigarettes, moderation in alcohol intake, eating a high-fiber (a lot of vegetables, fruits and nuts and grains, and minimal red meat) diet, helps greatly to minimize the occurrence of colorectal cancer. Fecal occult blood test annually and colonoscopy every five years for screening for those 50 and over are highly recommended to assure early detection and higher cure rate of this malignancy, if found. A simple and inexpensive test for occult blood in the stools could make the difference between life and death. In majority of cases, colorectal cancer, and death from this malignancy, are preventable.

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Author’s Notes: The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities, and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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Editor’s Notes: Philip S. Chua, MD, FACS, FPCS, is a Cardiac Surgeon Emeritus based in Munster, Indiana, and Las Vegas, Nevada. He is the chairman of Cardiovascular Surgery at Cebu Doctors’ University Hospital, Cebu City, Philippines,. He is also the Vice-President for Far East of Cardiovascular Hospitals of America, a hospital builder in Witchita, Kansas. His medical column appears in nine newspapers (five in the USA and four in the Philippines), three magazines, and 10 websites on the Internet. His email address is scalpelpen@gmail.com