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Q: Over the last few days, I've noticed an increasing amount of blood in my feces. Two days ago, it was just a small red blotch on the toilet paper, and today it was quite a bit more. There are signs of blood in the toilet water when I finish. I'm worried about the situation. Can you help me out?

-- M.K.

A: I don't blame you for being worried. Any bleeding is obviously a cause for concern, especially if it continues. I hope by now the cause has been identified and the bleeding has stopped.

Blood in the stool is an indication of bleeding somewhere in the digestive tract, anywhere from the mouth to the anus. This bleeding is usually caused by damage to the wall or lining of the digestive tract or to the blood vessels supplying it.

The physical appearance of the blood and the quantity seen provides clues as to the location and extent of the causative injury.

If the blood is black or "tarry," called melena, the bleeding is likely confined to the upper digestive tract, particularly the stomach or small intestine. The black color results from the blood's exposure to digestive juices.

Ulcers, torn tissue, tumors, blood vessel abnormalities and irritation of the wall of the stomach or small intestine may cause upper digestive tract bleeding. About half the people with upper gastrointestinal bleeding are over 60.

If the blood is bright red, called hematochezia, the bleeding is likely to be in the lower gastrointestinal area -- the large intestine or anorectal area.

Some hematochezia can be due to massive upper gastrointestinal bleeding, however.

The severity of bleeding can range from streaks of red blood in stool to massive, large-volume hematochezia, which could be the result of bleeding anywhere in the lower gastrointestinal tract.

The causes of lower digestive tract bleeding are also many and varied. A lot depends on your age. For people under 50, the more common causes include infectious colitis, anorectal disorders like internal hemorrhoids or anal fissures, and inflammatory bowel disease.

For your type of bleeding, if not accompanied by pain, it's probably due to internal hemorrhoids. If you also have pain, you need to consider a fissure or tear.

For older people, diverticulosis is the most common cause. Tumors, infections and irritation of the intestinal wall are also problems.

Unfortunately, often the most dangerous bleeding in your stools is bleeding that you cannot detect with the eye at all (called "occult"). In this situation, the amount of blood is too small to see or turn the feces dark.

But this may be the first sign you have of a tumor of the digestive tract, with the colon being the most common site. So it's very important to check your feces for occult blood on a regular basis especially as you get older.

This can be part of a doctor's visit or you can buy a test kit yourself and check it at home.

Most of the time, the bleeding you are experiencing will be minor and stop by itself. But if it continues, especially if you are experiencing increasing amounts of blood streaking, I suggest you seek medical care to determine the diagnosis and treat the underlying cause.

Please write down a complete medical history of this problem and take it with you. And please don't let the possibility of the need to look into your colon stop you from a needed visit.

Update on breast cancer: A study recently published in the Journal of the National Cancer Institute indicates that a particular virus (Epstein-Barr) was found in the majority of breast tumors. This virus was also found more frequently in the more aggressive tumors.

It's not known if the virus is a cause of breast cancer or if cancerous tissue simply attracts the virus. But finding it in breast tumors may be a good indication to choose more aggressive treatments.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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