Rectal bleeding is when you see blood when wiping on toilet paper or when you observe your stool. This symptom can be an indicator of various conditions such as haemorrhoids, anal fissures, inflammatory bowel disease (IBD) and colorectal cancer. It is important to contact a healthcare professional about rectal bleeding because not all causes may be serious, but some can be.
What is rectal bleeding?
Looking in the toilet and seeing blood in your faeces (stool) can be quite frightening. Your mind can go many places as warning bells ring that something is wrong. Rectal bleeding can be a symptom of many different conditions, some more serious than others. It is important to find the cause of rectal bleeding.
Some causes, such as haemorrhoids, may not require treatment. But others, such as colorectal cancer, require emergency care. Ulcers, anal fissures, and inflammatory bowel disease (IBD) are among other possible causes. A health professional can help determine the cause of rectal bleeding or ‘haematochezia’, the medical term for blood in your stool.
How does rectal bleeding occur?
You may see or experience rectal bleeding in several different ways, including
Noticing fresh blood on the toilet paper when you wipe.
Seeing blood in the toilet bowl after using the toilet. The water in the toilet bowl may appear to be dyed red.
Seeing bright red, dark red or tar black faeces in the toilet bowl.
When blood comes out of your anus (butt hole), we call it rectal bleeding, but actually blood can come from anywhere in the gastrointestinal (GI) tract. Your stomach, small intestine, large intestine, rectum and anus are all part of a continuous pathway, and all gastrointestinal bleeding comes out the same way.
What does blood in stool look like?
When you have blood in your stool, it can appear in several different ways. You may have bright red streaks of blood in your stool, or you may see blood clots or a mixture of blood and phlegm.
Your stools may also look dark, black and tarry. The colour of the blood you see can be a clue to where it is coming from:
Bright red blood in your stool usually indicates that the bleeding is further down in your large intestine, rectum or anus.
Dark red or crimson blood may indicate that the bleeding is further up your large intestine or in your small intestine.
Melena (black faeces) often indicates stomach bleeding, for example a bleeding stomach ulcer.
Sometimes, rectal bleeding is not visible to the naked eye and can only be seen with a microscope. This is called occult bleeding. You can discover such blood in a laboratory test on a stool sample; this test is called a faecal occult blood test. It is a screening test for colorectal cancer.
Is Blood in the Stool Serious?
Not always, but it can be. It is always a good idea to consult a health professional when you have rectal bleeding or blood in your stool. Some minor conditions may not require treatment, but sometimes they do. Rectal bleeding may also be a sign of a more serious condition that requires treatment.
Is Bright Red or Dark Colour in Stool Serious?
Lighter coloured blood in your stool can be more worrying because it indicates active bleeding. Darker blood usually indicates older bleeding that is no longer active. However, darker blood in your stool can be misleading. It does not always mean that the bleeding has stopped, it just means that it is coming from a higher place.
Upper gastrointestinal (GI) bleeding can take longer to move through your body and out of your anus. The digestive chemicals in it when travelling on the road make the blood darker over time. The brighter red blood comes from further down. This can be caused by something relatively harmless, for example a tissue wound. Upper GI bleeding is less likely to be harmless.
Blood in the stool: When should you be concerned about blood in stool?
It can sometimes be confusing to understand when you should be concerned when you see blood in your stool. However, there are some important signs to consider when assessing the situation:
If you don't know the cause: If the cause of the bleeding is unclear, it is normal to be concerned. It is especially important to consult a health care professional if you have not experienced such a situation before or if the bleeding has occurred suddenly and unexpectedly.
Is There Pain: Bleeding can usually be painless, but if there is pain, this can increase the severity of the condition.Pain in the anus or rectum area may be a sign of a fresh wound or other internal problem.
Amount and Frequency of Bleeding: The severity and frequency of bleeding is also important. Severe or frequent bleeding can lead to serious blood loss and may require immediate medical attention.
Continuous Bleeding: If bleeding continues for more than a week, it is important to find the underlying cause and initiate appropriate treatment. Bleeding that continues over time can lead to significant blood loss in the body and other health problems.
If any of these signs are present, it is important to contact a health professional. It is always best to contact your doctor to feel better and start treatment early.
Possible Causes
What causes rectal bleeding?
There are many different reasons why you may experience haematochezia - rectal bleeding or blood in your stool. These range from common and mild conditions to more serious and rare conditions that require immediate medical attention. Sometimes other symptoms can provide clues about the possible cause.
Common causes of rectal bleeding include the following:
Haemorrhoids:
Haemorrhoids or piles are swollen veins inside your rectum or anus. They are very common and are the most common cause of rectal bleeding. These veins swell close to the skin surface and sometimes the skin breaks and they bleed. They are not serious. They are usually associated with pressure or straining, such as pregnancy, heavy lifting or straining when defecating.
Anal fissure:
An anal fissure is a tear in the inner lining of your anal canal. Like haemorrhoids, it often occurs after trying to pass a hard stool. Anal fissures can be confused with haemorrhoids. Both are associated with constipation and both can cause anal pain and bleeding. A fissure may be more painful. Both can heal on their own, but sometimes treatment may be needed for a fissure to heal.
Inflammatory bowel disease (IBD):
Inflammatory bowel disease (IBD) causes chronic (continuous) inflammation of the inner lining of your intestines - your small and large intestines. Crohn's disease mostly affects your small intestine, while ulcerative colitis mostly affects your large intestine. IBD causes chronic abdominal pain and diarrhoea and, when severe, can cause bleeding.
Diverticulitis:
Diverticulitis occurs in your colon, usually at the lower end near your rectum. It occurs when small pockets - diverticula - in the inner lining of your colon become infected and inflamed. Inflammation in these pockets can make the blood vessels inside more fragile and more prone to bursting. In this case, it can cause acute rectal bleeding.
Other possible causes include:
Infectious colitis:
Some bacterial infections, such as E. coli and C. diff, can cause bleeding from your colon. This usually manifests as bloody diarrhoea. You will know this if you have an infection and most of the time it goes away on its own. However, some infections may require antibiotics. If you feel sick for several days, contact your health care provider.
Sexually transmitted infections (STIs):
Certain common STIs, including gonorrhoea, chlamydia and syphilis, can cause inflammation and bleeding in your anal or rectal lining. Herpes can lead to bleeding sores and human papillomavirus (HPV) can cause anal warts and may cause some bleeding. Many STIs require specific treatment, so it is important that they are diagnosed.
Peptic ulcer disease:
Peptic ulcers form in your stomach or duodenum. When stomach acid erodes the protective lining, it forms open sores. An ulcer causes a burning or gnawing kind of stomach pain and may bleed. Bleeding in the upper GI tract lasts longer, so the blood may be dark, black and tarry.
Colon polyps and colorectal cancer:
A polyp may look similar to a fungus growing next to your intestines. Polyps are common and larger ones can bleed. In some cases they turn into cancer, and cancerous polyps bleed more than others. Your healthcare professional may want to investigate unexplained rectal bleeding with a colonoscopy to exclude colon cancer.
Can having too much difficulty using the toilet cause rectal bleeding?
Yes, constipation and straining when using the toilet can cause rectal bleeding. When you strain, conditions such as haemorrhoids or anal fissures can occur and these can lead to bleeding. Very hard faeces can tear the skin inside the anus and cause bleeding. Treating your constipation can help prevent this from happening.
Causes of Blood in Stools in Babies and Children
Babies and children can also experience haemorrhoids and anal fissures due to straining during defecation. Anal fissures are the most common cause of rectal bleeding in children.Children may also have infectious colitis.However, they are less likely to have chronic diseases that develop over time, such as IBD, diverticulitis or colon cancer.
Are the causes of rectal bleeding the same for men or women?
The causes of rectal bleeding are mostly the same for men, women or either sex.Women and people with AFAB (at birth female assigned) can also have endometriosis. Rarely, endometriosis can cause rectal bleeding if it spreads to your lower intestine or rectum. The tissues can become inflamed and bleed during your menstrual cycle.
Can foods cause blood in your stools?
Food can change the colour of your stools. If you think you see blood in your stools, remember what you have eaten recently. Foods such as beetroot, tomatoes, blackberries or red food colouring can appear red or bloody when they appear in your stools. If you are taking iron supplements, this can make your stools appear dark or black.
Care and Treatment of Rectal Bleeding
Healthcare professionals can use several different methods to determine the cause of rectal bleeding or blood in your stool. To determine the cause, they may start by asking you questions about the circumstances surrounding your rectal bleeding or blood in your stool. This can help narrow down the possible causes.
They may ask the following
When did your rectal bleeding start?
Do you have pain with rectal bleeding or not?
Do you see blood in your stool, or is it when you wipe it away?
What does the blood in your stool look like? Are there streaks or clots?
How was your stool? Was it watery or hard?
Do you have diarrhoea or constipation?
Did you have difficulty passing stools when you saw blood in your stool?
How often do you pass stools?
What did you eat the day before you had blood in your stool?
What medicines did you take the day before you had rectal bleeding?
Did you drink alcohol the day before you had rectal bleeding?
Do you have haemorrhoids?
Do you have diverticulosis?
Do you have inflammatory bowel disease?
Do you have a family history of colorectal cancer?
Your answers to these questions can help your healthcare professional decide which medical tests to perform. These tests may include the following:
Digital rectal examination: A physical examination of your rectum and anus.
Anoscopy: Examination of your anal canal with a small magnification.
Proctoscopy: Examination of your rectum and anus using a short, rigid instrument.
Flexible sigmoidoscopy: An examination using a longer instrument to see your lower colon.
Rectal culture swab: A bacterial culture to identify infections.
Stool test: Healthcare professionals can check a sample of your stool for signs of active bleeding, hidden blood or inflammation. They can also check for certain infections.
Colonoscopy: A colonoscopy, a common screening test for colon cancer, is an examination of your entire large intestine with an illuminated camera at the end of a long tube.
Upper endoscopy: Your healthcare provider may recommend an upper endoscopy if they suspect upper GI bleeding. The endoscope travels from your throat through the stomach and duodenum.
What is the treatment for rectal bleeding?
Treatment of rectal bleeding usually involves treating the disease that is causing it. The treatment will depend on many different factors. If your rectal bleeding is caused by a ruptured anus or a haemorrhoid that you can reach, you may be able to treat it at home with tropical ointments.
Will rectal bleeding stop on its own?
Whether rectal bleeding stops on its own depends on the cause. If it stops and does not come back, it will probably not need further treatment. However, you should always observe any rectal bleeding or blood in your stool. Pay attention to whether it happens more than once or if you have any other symptoms.
What questions should I ask my doctor about rectal bleeding?
If you are experiencing rectal bleeding, you and your healthcare provider will want to know why it is happening and what to do about it. Your healthcare professional will try to determine the cause of your rectal bleeding and the type of treatment you need.
During this process, questions you may want to ask include
Is my rectal bleeding related to a condition I know I have?
Are there any other symptoms I should be aware of?
What tests will I need to diagnose the cause?
What are my treatment options for this condition?
How should I look after myself when I have rectal bleeding?
Can I prevent future episodes by changing my diet, medication or habits?
Bleeding creates a special, primal anxiety, especially when you cannot see where it is coming from. It can feel difficult to wait for a medical appointment to find out what your rectal bleeding means.Remember, although there are many possible causes, the most common ones are easy to find and correct.
Don't be embarrassed to talk to a health care professional about rectal bleeding or blood in your stool. These are important symptoms and health professionals will want to know all about them. Answering your questions as completely and honestly as possible will help them determine the type of care you need.
