Blood in Stool: After Chemotherapy and Its Management:

Blood in stool after Chemotherapy and its management can be a serious emergency if not treated immediately. If it is black in colour, it is caused by bleeding from the stomach or small intestine.

However, if a person notices this, especially 5-6 days after chemotherapy, never delay in seeking medical attention and consult your Oncologist.

It can be due to low platelet count and an altered coagulation profile as side effects of chemotherapy. When blood becomes mixed with gastric acid, it turns black. In medical terms, it is called melena.

Signs and Symptoms of Blood in Stool

The following are the signs and symptoms of Malena (black stools)

• Loose stools (black)
• Abdominal cramping: the patient feels abdominal cramps when the loose stools pass through the intestines.
• Nausea/vomiting (coffee ground): when there is bleeding in the stomach, it gets mixed with stomach juices, and its color changes to coffee ground colour. When a patient experiences such a color of vomit, must get medical help.
• Burning sensation in the stomach and belly
• Swollen belly: When the loose stools get collected in the abdomen, it causes swelling and inflammation, resulting in abdominal swelling /swollen belly.
• A feeling of fullness due to filled blood and fluid-filled content in the gut. Due to this feeling patient will not want to take food by mouth.
• Decreased appetite: The patient will have less desire to eat due to nausea and vomiting or a full gut due to bleeding. In some severe cases, it is necessary to keep the patient NPO( nothing per oral ), this help the gut to take rest.
• Your healthcare provider will treat to stop the bleeding by giving blood products and medications.

Seek Medical Attention

Consult your doctor if you notice the above-mentioned symptoms

Care at Home: Blood in Stool after Chemotherapy and Its Management:

Home care of a patient with gastrointestinal bleeding is very important; the patient should be in the hospital at this stage, but some home care is needed for the safety of the patient. However, if you notice black stools at home, take the following measures.

• Avoid taking medications for pain, especially NSAIDS, which can worsen bleeding.
•   Avoid taking alcohol or drinks containing alcohol or more acidic foods.
• Try to take a CLEAR LIQUID DIET, or it is recommended not give anything peroral.
• If you cannot reach the hospital concerned immediately, get your complete blood count and coagulation profile from an authentic laboratory so that you can get the emergency treatment on time without any delays.
• Maintain hydration by drinking oral rehydration solution (ORS) in case of mild loose stools. If loose stools get worse, nothing oral is suggested to give rest to the gut for fast recovery.

Complications of Excessive Blood in Stools:

As discussed above, black stools are due to bleeding from the stomach and small intestines. Furthermore, if a patient does not seek medical attention on time, they can go into hypovolemic shock and even die.

The following symptoms should be addressed and considered as emergency alarming signs

• Severe dehydration due to large volume losses.
• Severe low blood pressure(due to heavy loss of blood)
• High pulse rate (tachycardia) due to the high demand for volume to the heart due to severe dehydration.
• Decrease in hemoglobin levels due to excessive internal bleeding
• Very low platelet count as a side effect of chemotherapy, if occur after the chemotherapy cycle.
• Fever due to low white blood cell count is an indication of infection.
• Shortness of breath due to low hemoglobin level. Hemoglobin helps in the transportation of oxygen from the lungs to the body.
• Fainting or loss of consciousness (due to very low blood pressure and decreased hemoglobin level)
• Weakness due to low blood and fluid volume in the body (hypovolemia)
• Dizziness due to low blood flow to the brain
• Dry mouth (due to severe dehydration)
• Sunken eyes are a sign of severe dehydration.
• Although these symptoms are dangerous for both adults and pediatric patients. However, children may go into shock in very little time. So, do not delay in reaching the hospital.

What is the medical management for blood in stool?

Treatment: Blood in Stool after Chemotherapy and its management:

When you notice the black stool, do not ignore it and immediately seek medical attention. Furthermore, your healthcare team will manage you in the following ways:

• Your dehydration will be corrected by administering IV fluids, especially fluids containing electrolytes. As in loose stools and blood loss severe electrolyte imbalance can occur.
• Your complete blood count and blood chemistry will be checked to check your hemoglobin level, platelet count, and electrolyte imbalance.
• Furthermore, your hemoglobin will be maintained by transfusing pints of blood according to your Hemoglobin level.
• Will transfuse platelets and FFPs(fresh frozen plasma) according to your platelet count and coagulation profile
• In severe cases, your physician might stop your diet by mouth and start nutrition by drip called parenteral nutrition.
• You will be given medications to stop bleeding.
• Your blood pressure, pulse, and oxygen level will be monitored according to your health condition.

Hence, your bleeding will be stable, and your oral diet will be resumed. Your consultant will discharge you home. Moreover, seeking immediate medical help will result in an excellent response to treatment, while delaying can lead to a medical emergency such as hypovolemic shock due to excessive blood loss and dehydration. If not treated on time, even death can occur. So, early management is essential to stop bleeding on time.

How to manage constipation due to iron supplements?

In conclusion, the black stools can be due to Gastrointestinal bleeding, OR it can be due to some medications like iron supplements. However, in case of bleeding, the stool will loosen like diarrhea due to a mixture of blood.

If you are on iron suplements no need to worry, just manage constipation, as most of the iron supplements cause constipation.

To prevent this side effect, increase water intake and use a high fiber diet . But if you have loose black stools with abdominal crapms do not use a high fiber diet, this could lead to further diarrhea and bleeding.

On the other hand, black stool due to iron supplementation will be hard, such as stool in constipation.