Body fluids are contained in their own departments and, ideally, do not mix. For example, blood is in the blood vessels and does not mix with saliva or urine.
Blood in saliva could be that you bit yourself, as often happens when food tastes great. Or, perhaps, you were sucker-punched by the bus conductor. Otherwise, seeing blood in your urine, stool, brain fluid or saliva is not normal and should set alarm bells ringing.
Blood in brain fluid
Bleeding into the brain fluid occurs commonly following a head injury or after a stroke. Of course, if due to stroke, it can kill and so needs urgent investigation with a CT brain scan and management as required. It causes massive headache and patients sometimes describe it as the worst headache of their lives. It often feels like someone set off a bomb inside your skull.
Headache due to head injury, which may be as trivial as banging your head on the car door, can cause problems and should be checked out early. Headaches accompanied by dizziness, nausea and vomiting, fainting attacks and just general ill health demands attention by your general practitioner in the first instance. But, please, do not call it malaria or typhoid. Have a proper doctor examine and treat you as appropriate.
Blood in saliva or cough
Blood should not appear in your saliva or cough. In cough especially, it could signify an infection such as pneumonia or, God forbid, cancer. Now, the commonest cause is chest infection and the cough is painful, racking and distressful. The cough will be speckled with blood and not a frank fresh blood. If you see fresh blood, that is a bad sign and you must go to a hospital immediately. Cancer is the most obvious cause to be concerned about.
Blood in the chest is also a killer since it can interfere with breathing. The management must therefore be immediate and taken seriously. Please, do not be fobbed off and insist on proper diagnosis with CT or MRI scan of the chest. The management may also require a camera put into the air passage to actually see what is going on (bronchoscopy). A specialist can even stop the bleeding there and then.
Blood in your vomit
If you vomit fresh blood or even dark, foul smelling vomit, please endeavour to have someone look at you seriously. Fresh blood in the vomit could be pretty dangerous as a sign of a bleeding stomach ulcer. It can also lead to very black tarry stool. In the presence of previous history of stomach ulcer and severe pain in the centre of the chest, bloody vomit is an ominous sign of a torn blood vessel.
It can then appear in the stool (making it black) after being affected by the acid in the stomach. Long-term use or high doses of anti-inflammatory drugs such as aspirin, ibuprofen and naproxen can also cause ulcers. Regardless of the cause, an urgent transfer to hospital is critical and must be done without delay.
Blood in urine
Urine should be normal and dark. Foul, tea-coloured or frankly bloody urine demands review. Sometimes, what appears to be blood in urine is actually red pigment from other sources such as food dyes, certain medications, or an excessive amount of beets. This can occur in some people who eat beetroot.
The commonest cause of bleeding into urine is an infection. If there is blood in urine, an infection in the kidneys or bladder could be responsible. It can occur also following an operation where we have placed a tube into the bladder to remove urine.
In adults, bladder infections usually cause burning or pain with urination. Infants with bladder infections may have fever, be irritable, and feed poorly. Older children may have fever, pain and burning while urinating, urgency, and lower belly pain. Infection in the kidneys could also cause bleeding into the urine and are also associated with ill health, pain in the flanks and fever. In elderly patients, a bladder cancer is important to rule out. Send a sample to the diagnostic laboratory for review.
Blood in stool
Fresh blood in the stool could be due to trauma following cleaning-up after using the toilet. However, other things such as haemorrhoids (piles) can cause bleeding, which can be severe on occasions.
I once had a patient who nearly bled to death from a bleeding pile. A small cut or tear in the tissue lining the anus (anal fissure) similar to the cracks that occur in chapped lips can also cause bleeding. Fissures are often caused by passing a large, hard stool and can be painful.
The bleeding we are more concerned about is the fresh blood in the stool; but bleeding that happens higher up in the digestive tract may make stool appear black and tarry and could also be of real concern, too.
Polyps or cancer can cause bleeding. Polyps are benign growths that can grow, bleed, and become cancerous. Colorectal cancer is common and often causes bleeding that is not noticeable with the naked eye. Send a sample of stool to the diagnostic centre if you are concerned.
So, all in all, if you are seeing blood, see a doctor.