Blut im Stuhl – Ursachen

Blut im Stuhl kann viele Ursachen haben. Letzten Endes ist in mehr als 80% der Befunde ungefährlich. Doch da wir keinen unmittelbaren Einblick in den Magen-Darm-Trakt haben, was das Bluten eigentlich verursacht, ist es sinnvoll, sobald als möglich darauf zu reagieren. Genauso wie plötzliche Blutungen aus anderen Organen rasch abgeklärt werden sollten.

Im Folgenden sind die häufigsten Gründe aufgeführt.

Hämorrhoidalleiden – oder, zu große Hämorrhoiden

Hämorrhoiden sind an sich normale Gefäßpolster, die etwa in 5cm Entfernung vom Afterrand im Enddarm anzutreffen sind. Sie erfüllen die Funktion einer Abdichtung, die uns unter anderem vor unwillkürlichem Stuhlabgang bewahren.Bei einer entsprechenden krankhaften Vergrößerung der Hämorrhoiden, dem sog. Hämorrhoidalleiden, kommt es zu Beschwerden wie Juckreiz, Brennen, Bluten und Nässen.

Analfissuren – oder, der Afterriss

Bei Afterriss (Analfissur) handelt es sich um eine Verletzung der Haut des unteren Afterkanals, welche auch den inneren Afterschließmuskel betreffen kann. Beschwerden sind vor allem stechende Schmerzen während und nach der Stuhlentleerung, Blut auf dem Stuhl.

Tumore des Dünn- oder Dickdarms (nicht zwingend bösartig)

Lange können diese Arten der Veränderungen ohne Symptome einhergehen. Wird der Darm durch eine Einstülpung stärker eingeengt (sog. Invagination), kann dies zu Blutungen und damit zu sichtbarem Blut im Stuhl führen. Weitere Beschwerden können Verstopfung im Wechsel mit Durchfällen, starke quälende Blähungen oder auch bleistiftdünner Stuhlgang sein.

Polypen im Darm, oder Darmgeschwulste

Viele Polypen im Darm sind harmlos. Doch können sie auch mit der Zunahme an Größe entarten, d.h. sich bösartig verändern. Auch hier kann es zu entsprechenden Blutungen kommen. Eine stetig über längere Zeit bestehende Blutung führt zur Entleerung von schwarz-braunem Stuhl. Daher ist eine regelmäßige Darmspiegelung je nach vorheriger Empfehlung des Spezialisten wichtig, um die zumeist erst harmlosen Polypen zu sehen, und rechtzeitig zu entfernen.

Chronisch entzündliche Darmerkrankungen, Entzündungen anderer Ursache

Morbus Crohn, Colitis ulcerosa und alle anderen Darmentzündungen verschiedener Ursache (mikroskopische Kolitis, infektiöse Kolitis, nahrungsmittelbedingte Entzündungen usw.), muss man besondere Aufmerksamkeit schenken.

Meist leiden die Patienten unter schubweise starken Durchfällen und Bauchschmerzen/-krämpfen in verschiedenen Darmabschnitten. Die Durchfälle können blutig sein. Das Erscheinungsbild dieser Erkrankungen ist sehr komplex.

Divertikel (Aussackungen im Darm)

Divertikel sind Ausstülpungen im Darm, wodurch sich Entzündungen bilden können. Teilweise können Blutgefäße einreißen, die wiederum zu mehr oder weniger starken Blutungen führen können.

Infektionen des Darms

Ein Beispiel sind unsere normalen, nicht krankmachenden Verdauungsbakterien Escherichia coli (E.coli), die zu 80% unserer normalen Darmflora darstellen. Doch davon gibt es auch Unterarten, die sehr schwere Darminfektionen auslösen können. Des Weiteren sind auch Salmonellen, Clostridien oder Viren (Norovirus) im zunehmenden Maß zu nennen. Gerade diese Organismen sorgen oft in größeren Kantinen oder Einrichtungen, bei Reisegruppen o.ä. für rasch um sich greifende Infektionsausbrüche.

Dabei spielen das Alter und die körperliche Konstitution eine wichtige Rolle. Den gerade Kleinkinder oder ältere Menschen haben oft viel stärkere Symptome als ein gesunder Erwachsener. Hier kommt es oft nicht nur zum obligatorischen Durchfall, der in der Folge auch wieder Blutungen erzeugen kann, sondern gerade bei Infektionen des oberen Magen-Darm-Traktes zusätzlich zu Würgereiz mit Erbrechen.

Im unteren Darmtrakt äußern sich die Beschwerden eher mit explosionsartigen Durchfällen, Blut und Schleimausscheidungen.

Blutungen im oberen Magen-Darm-Abschnitt

Blut, was seine Ursache im Magenbereich (z.B. Magengeschwür) oder Zwölffingerdarm hat, kann sich auch im Stuhl zeigen. Das heißt, dass entgegen der allgemeinen Meinung, nur helles Blut aus dem unteren Darmbereich und dunkles Blut mit dem Darm nichts zu tun hat, nicht stimmen muss.

Oftmals werden wir eines Besseren belehrt und dann kann auch dunkles Blut auf einmal von unten kommen und helles Blut aus dem Magenbereich. Es kommt immer auf die speziellen Umstände an und sollte in jedem Fall rasch abgeklärt werden.

Blutabgänge aufgrund ärztlicher Untersuchungen oder Medikamente

Auch nach einer Magen- oder Darmspiegelung und nach erfolgten Gewebsentnahmen (sog. Biopsien) kann sich bis zu drei Tage nach der Untersuchung Blut im Stuhl finden. Sollten die Blutungen anhalten, ist der Arzt auf jeden Fall zu verständigen.

Und eben auch Medikamente, die uns gerade vor krankheitsbedingten Gefäßverschlüssen (nach entsprechenden Thrombosen, nach Infarkten) schützen sollen oder zur Behandlung bei chronischen Schmerzen eingesetzt werden, sind in nicht wenigen Fällen für plötzliche Magen- und Darmblutungen verantwortlich, zum Teil mit dramatischen Folgen.

Fazit

Blutungen aus dem Darm wie aus jedem anderen Organ auch (Scheide, Harnröhre, Ohren, Augen, Nase) sind immer ernst zu nehmen, wenn auch die Ursache doch in den meisten Fällen harmlos ist.

Zu wissen, worum es sich handelt ist immer besser als den Kopf in den Sand zu stecken.

Ihr

Dr. Stephan Potzler

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