Rectal Bleeding Overview
Sometimes people see blood on the toilette paper after wiping. Hemorrhoids are the most common reason, but rectal bleeding can also indicate a serious gastrointestinal condition that needs medical attention.
Rectal bleeding is a symptom of many different conditions, including hemorrhoids, anal fissures, inflammatory bowel disease (IBD) and colorectal cancer.
A few occasional drops or streaks of blood in the toilet when wiping or in the stool are usually not a worry. Around 13–34% of people experience bleeding from the rectum, and the most common cause it hemorrhoids or piles.
However, in some cases, bright red blood in the stool may indicate bleeding in the lower colon or rectum. Darker red blood is a sign of bleeding in the small bowel or upper colon. Very dark or black-red blood often means there is bleeding in the stomach or other organs of the digestive system.
Causes of rectal Bleeding
There is a wide range of reasons for blood in the stool. Many health conditions and factors can cause or add to rectal bleeding.
Some of the most common causes include the following:
Colon or Rectal Cancer
Cancer that impacts the colon or rectum can cause irritation, inflammation, and bleeding. The blood may appear bright red or can cause stool to have a darker color.
Colon cancer is a very common form of cancer and tends to progress slowly, so it is often treatable if caught early.
Rectal cancer, while far rarer than colon cancer, is also usually curable if detected and treated in time.
Some cases of colon and rectal cancer develop from initially benign polyps. All cases of gastrointestinal cancer require treatment, which varies based on the stage of the cancer but can involve surgery or a combination of chemotherapy, radiation therapy, and surgery.
Diverticulitis
Diverticulitis occurs when small pockets called diverticula develop on the walls of the colon around a weakness in the organ’s muscular layers.
These pockets are very common. Sometimes diverticula can start bleeding, but this usually stops on its own.
The pockets do not usually cause symptoms or require treatment unless they become infected infected.
Infected and inflamed diverticula often cause pain and can lead to rectal bleeding, usually a moderate flow of blood that lasts for a few seconds.
However, diverticular bleeding can at times result in a significant amount of blood loss. For this reason, a person should immediately seek medical attention. A person can recognize they may be experiencing diverticular bleeding if painless bleeding is coming from the rectum.
Doctors may treat diverticulitis with antibiotics and, in severe cases, surgery..
Fistulas
A fistula occurs when an abnormal opening or pocket develops between two neighboring organs. Fistulas that appear between the anus and rectum, or anus and skin, can cause a discharge of white fluid and blood.
Doctors sometimes treat fistulas with antibiotics, but they may require surgery if they progress.
Fissures
Anal fissures occur when tissues lining the anus, colon, or rectum tear, resulting in pain and rectal bleeding. In some cases, passing a hard stool can cause a tear. When they occur, they often cause bright red blood when passing a bowel movement.
Warm baths, a high-fiber diet, and stool softeners can all help reduce symptoms of fissures. In severe cases, fissures may require prescription creams or surgery.
Gastroenteritis
Bacterial infections can cause inflammation of the colon and stomach, causing diarrhea that may contain mucus and blood. Viral gastroenteritis does not typically cause bloody diarrhea.
Treatment for gastroenteritis usually involves fluids, rest, and antibiotics or antivirals, depending on the exact cause.
Hemorrhoids
Hemorrhoids are inflamed anal blood vessels. They are very common, affecting about 1 in 20 people and about 50% of Americans over the age of 50. They can develop on the outside or inside of the anus, appearing as small bumps that occasionally bleed during bowel movements or when wiping.
Piles or hemorrhoids can impact anyone of any age, but some people have a higher risk of developing them. A few risk factors include:
- Being over the age of 50
- Constipation
- Diarrhea
- Obesity
- Low fiber or unbalanced diet
- Often lifting heavy objects
- Pregnancy
- Sitting on the toilet for too long
- Straining during bowel movements
Hemorrhoids usually respond well to over-the-counter (OTC) creams and suppositories that contain hydrocortisone. Taking warm baths frequently, eating a high-fiber diet, and using stool softeners can also help reduce the discomfort of hemorrhoids.
If initial treatments fail, a doctor may perform minor surgery to remove the hemorrhoids.
Internal Bleeding
Major injury to any of the gastrointestinal organs can result in internal bleeding that passes through the rectum. Severe gastrointestinal disease can also lead to internal bleeding.
A person should see their doctor if they suspect internal rectal bleeding. The doctor will likely order a colonoscopy.
Polyps
Polyps are noncancerous, abnormal growths. When polyps grow on the lining of the rectum or colon they can cause irritation, inflammation, and minor bleeding.
In many cases, a doctor will typically remove polyps during a routine colonoscopy screening.
Prolapse
Weakened rectal tissues can allow a portion of the rectum to push forward or bulge outside of the anus, usually resulting in pain and, almost always, bleeding.
Rectal Prolapse can occur at any age; however, females over the age of 50 have a 6 times higher risk of developing a prolapse compared with males.
Typical treatment involves surgical intervention.
Proctitis or Colitis
Proctitis occurs when the tissues of the rectum become inflamed, often resulting in pain and bleeding.
Colitis occurs when the tissues lining the colon become inflamed. A type of colitis, called ulcerative colitis, can also cause ulcers, or open, progressive sores, that often bleed.
Treatments for proctitis and colitis vary, depending on the causes. They range from antibiotics to surgery.
Common causes of proctitis and colitis include:
- Anal intercourse
- Blockage in the colon or rectum
- Certain conditions that cause digestive problems, such as Crohn’s disease
- infection
- Radiation or chemotherapy
- Some medications, such as blood thinners
- Reduced blood flow to the colon or rectum
Sexually transmitted infections (STIs)
Unprotected sexual intercourse that involves the anal area can spread a wide range of viral and bacterial diseases. These can cause inflammation of the anus and rectum. Inflammation, if it occurs, increases the likelihood of bleeding.
Treatment for STIs usually involves either an antibiotic, antiviral, or antifungal medication based on the type of infection.
Severe and Chronic Rectal Bleeding
Occasional minor to mild rectal bleeding is common and will often not need medical attention or treatment.
Severe, chronic, or painful rectal bleeding may be a sign of a more serious underlying condition, which a doctor should assess.
People normally notice rectal bleeding when they see streaks or drips of blood in their stool, the toilet bowl, or when wiping. Some people may also find blood in their underwear, or the toilet water may appear reddish-pink after they go to the bathroom.
Some cases of rectal bleeding also cause very bad smelling, dark, tarry stool mixed with dark red to black blood.
Signs and Symptoms of rectal bleeding include:
- Bleeding that lasts longer than a few days
- Children with bloody stool or rectal bleeding
- Fatigue
- Fever
- Painful, swollen, or tender abdomen
- Simultaneous lumps in the abdomen
- Stool that is thinner, longer, or softer than normal for several weeks
- Nausea or vomiting
- Long-term constipation or changes in bowel habits
- Uncontrolled leakage from the anus
- Unexplained Weight Loss
- Weakness
Reasons to seek emergency care for rectal bleeding include the following:
- Back pain
- Coughing up blood
- Extreme abdominal or lower back pain
- Blood running from the nose, eyes, or ears
- Bleeding that is very dark red or black
- Loss of consciousness or confusion
- The reason for bloody diarrhea is unclear, such as unrelated to an abdominal condition or medical treatment
- Vomiting
Diagnosis of Rectal Bleeding
If bleeding is associated with an already diagnosed medical condition, a doctor will discuss ways to manage, reduce, and track symptoms.
If the cause of rectal bleeding is unknown, a doctor will normally ask questions about symptoms and the person’s medical history.
Depending on the severity, frequency, and accompanying symptoms, the doctor will work out if further testing is required. A doctor may also make a referral to a gastrointestinal or colorectal specialist.
Common tests associated with rectal bleeding include:
- A physical examination of the anus and rectum
- Analysis of a stool sample
Doctors may perform additional tests that can include the following:
- Anoscopy, where a doctor inserts a device into the anus to examine the tissue
-
Biopsy or removal of a small tissue sample for examination
-
Computerized tomography (CT) scan, which provides a 3D image
-
Colonoscopy or flexible sigmoidoscopy, where the doctor examines the colon with the insertion of a tube with a camera
Treatment of Rectal Bleeding
Treatment for blood in the stool or when wiping depends on the exact cause of the bleeding.
For example, OTC and prescription creams can often treat hemorrhoids, while a diet rich in fiber or surgery may help with diverticulitis.
Common treatments include:
- Antibiotics
- Eating more fiber
- Procedures such as a colonoscopy, or, in some cases, surgery to remove part of the colon
- Topical creams or ointments
A patient should talk with their doctor about what treatment options work best for them.
Prevention of Rectal Bleeding
In some cases, there is no real way to prevent minor cases of rectal bleeding. However, some factors are known to cause, contribute to, or worsen anal bleeding.
Common prevention tips for rectal, colon and anal bleeding include the following:
- Avoid spicy, rich, fatty, heavily processed, and refined foods
- Always staying hydrated
- Avoiding overuse of nonsteroidal anti-inflammatory drugs (NSAIDs)
- Don’t lift heavy objects unless required
- Eating a balanced diet that is high in fiber
- Following treatment plans set out by a doctor for related medical conditions
- Maintaining a healthy body weight
- Seeing a doctor about abnormal growths in the area
- Not straining when going to the washroom
- Treatment of chronic or prolonged constipation with OTC such as stool softeners
- Taking long, warm baths frequently if experiencing symptoms
- Treating chronic or prolonged diarrhea with OTC remedies, such as bismuth subsalicylate
- Wearing a condom during anal sex
- Wiping the anus gently
Patients should talk with a doctor about gastrointestinal symptoms that may be a sign of underlying conditions, including infections, digestive conditions, or abnormal growths.
Summary
Many times, a small amount of blood in the stool or when wiping is not a reason for concern. However, in some cases, it could mean bleeding in the rectum or colon. If the blood is very dark, this could mean the bleeding is coming from the digestion system.
There are numerous, possible causes of rectal symptoms. Each one may have different additional symptoms. If a person finds bleeding in the toilet after a bowel movement or when wiping, it is a good idea to see a doctor to rule out any serious conditions.
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