About: Bright red blood either through or on the outside of feces is known as hematochezia. It is a sign of bleeding in the lower intestines (colon and rectum).
Causes: It has many causes including tumours (benign and cancerous), colitis, bacterial, viral or parasitic infection, blood clotting disorders, anal gland rupture, and polyps.
Diagnosis: Thorough physical examination along with baseline tests including complete blood count, biochemical profile and urinalysis. Additional tests may include imaging, fecal exam, biopsy, colonoscopy and coagulation profiles.
Treatment: Depends on the underlying cause.
It is always alarming when we discover blood in your cat’s stool but in a lot of cases, the cause is minor and transient. Blood in the cat’s stool may be light, with just a smear or speck or heavy and it may be with or without accompanying symptoms.
Melena – Tarry black stools are associated with upper gastrointestinal tract bleeding including the esophagus, stomach, and duodenum but bleeding may also originate from the nose or mouth. The blood is broken down by bacteria in the stomach before moving to the lower intestinal tract and out of the anus.
Hematochezia – Bright red blood which is associated with lower intestinal (colon and rectum) and anal bleeding. This type of blood in the stool is much more obvious than melena. It may be throughout the feces or just on the outside.
This article focuses on bright red blood in the stool.
The occasional sighting of bright blood in the feces is usually insignificant, however, if it lasts longer than a day if there is a large volume of blood passed and/or if other symptoms are also present, see your veterinarian. There are many possible causes of blood in the cat’s feces, some of which include:
Cryptosporidium causes inflammation which leads to bleeding, parasitic worms such as hookworm or roundworms suck the blood from the intestinal wall, resulting in blood in the stool. Parasites are one of the most common causes of blood in stool in kittens.
Bacterial infection, salmonella, campylobacter, and e.coli.
Panleukopenia is a highly infectious viral infection which affects the white blood cells. Kittens are most at risk of this disease. Symptoms can include loss of appetite, listlessness, vomiting, bloody diarrhea, and dehydration.
Difficulty passing feces. Hard, dry stools can cause irritation and/or minor tears in the bowel and anus.
The anal glands are two small sacs on either side of the anus when the cat defecates, the glands release a thick, foul smelling substance. Sometimes these glands become impacted and inflamed, leading to infection and/or an abscess.
Consumption of a hard object such as a bone fragment or hair which irritates the lining of the colon.
Cats of any age can develop a food allergy to a particular ingredient. In cats, allergies typically affect the skin, although it can also affect the GI tract.
Inflammation of the gastrointestinal tract. The cause still isn’t entirely understood but it is thought to be due to the presence of bacteria, dietary intolerance or parasites. Inflammatory cells infiltrate the mucosa leading to inflammation.
Nosebleeds or bleeding from the gums (blood clotting disorders)
Often there will be no accompanying symptoms, but this doesn’t rule out an underlying problem. If you notice blood in your cat’s stool more than once or twice, it needs to be investigated, even without other symptoms present.
If possible, bring along a stool sample or take a photo to show your veterinarian. If you suspect your cat has ingested poison, bring along the packaging if possible. Your veterinarian will perform a complete medical and rectal examination and obtain a medical history from you. He will ask about your cat’s stool.
Is it firm and well formed with blood on the surface? This type of stool may be due to polyps, constipation or anal gland disorders.
Is it loose with blood mixed on the surface or mixed into the stool? This may be suggestive of an inflammatory or irritative disorder although cats with colitis can also pass firmly formed stools also.
Has your cat had any recent medications? Prescribed or nonprescribed.
When did you last worm your cat?
Cats who pass firm stools most often have constipation, polyps or anal gland issues. Whereas soft/loose stools are more commonly associated with inflammation or infections. He will need to perform further tests to determine the cause of bleeding. These may include:
Abdominal x-rays to look for growths, foreign bodies and check the internal organs
Abdominal ultrasound to look for growths, foreign bodies and check the internal organs
Biopsy – If a mass is found, your veterinarian may wish to perform a biopsy to examine a sample of the cells
Colonoscopy – Visual examination of the colon with an endoscope while the cat is under sedation.
Coagulation profiles – To evaluate your cat’s blood clotting ability
Treatment depends on the underlying cause and may include the following:
Laxatives and/or stool softeners to treat constipation. Increase fibre and water consumption in the diet.
Intestinal parasites (worms and Cryptosporidium)
Medication to treat parasitic worms.
There are no effective medications to treat cryptosporidium, however, some veterinarians will prescribe antiprotozoal drugs to immunocompromised cats. Supportive care is the mainstay of treatment for cryptosporidium including fluids to treat dehydration and anti-diarrheal medications.
Oral antibiotics and supportive care where necessary, this may include fluids to treat dehydration. Your cat may be put on a bland diet for a few days to rest the gastrointestinal tract if vomiting and diarrhea have occurred.
Elimination diet, in which the cat will be fed a prescription diet which it has had no prior exposure to (such as duck or kangaroo). During this time, do not give the cat any other food or treat as this will invalidate the trial. If the allergy symptoms clear up, the cat will then be re-introduced to his previous diet to see if symptoms return.
Polyps and tumours
Surgery to remove polyps or tumours. Chemotherapy as a follow up in some cases.
Your veterinarian may give your cat an enema to try and flush out the foreign body. If this isn’t possible, surgery will be necessary to remove the object(s).
Impacted anal glands
Drain and flush the glands. If the problem recurs then your veterinarian may decide to remove the anal glands.
Inflammatory bowel disease
A highly digestible, high-fibre, low-fat diet. Corticosteroids such as Azathioprine or Sulfasalazine to suppress the immune system. Antibiotics such as metronidazole may also be necessary.
Blood clotting disorders
Find and treat the underlying cause if possible. Supportive care such as whole blood or plasma transfusions may also be necessary as well as Vitamin K injections.
Gastric decontamination where possible, such as induce vomiting or pump the stomach. Vitamin K injections to help with blood clotting.
See inflammatory bowel disease.
The prognosis is poor, kittens are at greatest risk due to their immature immune system. Supportive care is necessary while the cat fights the infection. This may include blood transfusions, antibiotics to fight secondary bacterial infections (they won’t kill the panleukopenia virus), fluid and electrolyte replacement and nutritional support.
Slippery elm is a herbal remedy which has many medical uses. It contains a mucilige (a gelatinous substance) which coats and soothes the intestines and stomach as well as increasing mucus secretion which protects the gastrointestinal tract.
Probiotics: Yoghurt contains a type of bacteria known as Lactobacillus, these bacteria normally reside in the intestines, helping with the digestion of food. Sometimes the natural flora of the gut is thrown out of balance (for example if your cat is on a course of antibiotics), and this can lead to opportunistic and pathogenic strains of bacteria taking hold.