Running with Crohn’s: Bleeding

Anemia and bleeding are not unique to Crohn’s Disease, however, people who suffer from inflammatory bowel disease often suffer from intestinal bleeding and anemia.

I haven’t suffered from anemia in many years, perhaps as many as ten.  However, I spent the 13 years before these last 10 years suffering from chronic anemia caused by slow (or sometimes very fast) bleeding.  Since then, I have occasionally suffered from bleeding but it has been slight compared to what I used to experience and it hasn’t caused anemia.

Sometimes it isn’t always easy to tell when I’m bleeding.

When I bleed a lot from Crohn’s damage to my intestines, the bleeding occurs in my small bowel and my stool is often black.  When I bleed from fistula damage, it is always red and usually it is bright red.  However, sometimes when I bleed from my Crohn’s and have severe diarrhea, the stool is dull red, black with red tints, or very dark brown.  Sometimes the color of my stool is very dark but not black or red and I can’t really tell whether I’m bleeding or not.  The only way to tell with certainty is to get your stool tested.

Having spent over a decade bleeding on and off from my disease, I’ve come to the conclusion that the color of my stool, in regards to bleeding from Crohn’s disease, depends upon the amount of time the blood spends in my intestines.  The longer the blood remains in the intestines, the more it turns the stool black rather than red.  Blood coming from the very end of my intestines (like from my fistula) is always red.  Sometimes it’s bright red and sometimes it’s dark red but it is always red.

For more information about what the color of your stool might mean, read my early entry "Everything comes down to poo."

In 1998, I suffered from a very serious bout of bleeding.  Ultimately, the doctors determined that the Crohn’s ulceration had worked into an artery running along my intestines.  In a few days, I went from hemoglobin of 16 g/dl to 6 g/dl.  Over several more days, I received many tests and seven units of blood in transfusion.  After finally finding the source of the bleeding (and three more units of blood), an emergency small bowel resection fixed my bleeding problems by removing the Crohn's Disease afflicted section of the intestines.  It took me nearly 3 months to recover from the surgery and blood loss.  Ironically, suffers of Crohn's Disease redevelop the Crohn's ulcerations at the resection point of the intestines - and I am no exception.  Colonoscopies subsequent to my surgery revealed that my Crohn's is back and just about as severe as it was prior to the surgery.

For me, fistula bleeding also contains a discharge that either looks like (or probably is) pus or mucus mixed with the blood.  I usually get this bleeding during bowel movements.  When I have had bad infections with the fistula, I also sometimes get large “discharges” of pus and blood that I can actually feel coming out.  Other times (like now) the discharge is gradual and produces no real feeling.  My body has never experienced trouble with maintaining my hemoglobin levels due to the bleeding associated with my fistula.

If you suspect blood in your stool (or you have very dark stools), you should ask your doctor to test you for both anemia and “fecal occult blood” (blood hidden in your stool).