Q: Does the excess intake of salt in a Salt-wasting, Classical CAH patient, place increased stress on an infant’s colon/GI system, leading to increased occasions of blood in the stool?

A: Steroids in very high doses can cause inflammation of the lining of the stomach (called gastritis), which could potentially lead to dark blood in the stool (the color would be dark due to digestion and passage through the intestines). However, the steroid doses generally used for the treatment of CAH are more in the physiologic range, so they should not cause bleeding.

If the blood is bright red, the more likely culprit is anal fissures, which are fairly common infants and can be a result of hard stools. Your pediatrician should be able to tell you if your infant has anal fissures pretty easily.