Rectal Bleeding: What Patients Should Know
Dr. Matthew J. Finnegan a robotic colorectal and general surgeon with Shore Physicians Group in Somers Point, New Jersey discusses the causes of rectal bleeding. One of my first thoughts is that most people wait too long to seek help because they think it will stop or there is some social stigma associated with discussing our personal abnormal bowel habits.
Seeing blood after a bowel movement can be alarming, but rectal bleeding is a symptom—not a diagnosis. Many causes are common and treatable, such as hemorrhoids or small tears near the anus, but bleeding can also come from conditions that need prompt medical attention. If you notice blood in the toilet, on toilet paper, or mixed with stool, it is important to tell your healthcare provider so the cause can be identified.
What Rectal Bleeding Can Look Like
Rectal bleeding may appear in different ways. You may see bright red blood on toilet paper, streaks of blood on the stool, blood dripping into the toilet bowl, maroon-colored stool, or black, tar-like stool. Bright red blood often comes from the lower colon, rectum, or anus, while darker or black stool may suggest bleeding from higher in the digestive tract.
Common Causes
- Hemorrhoids: Swollen veins in or around the anus or rectum. They may cause bright red bleeding, itching, discomfort, or a lump near the anus.
- Anal fissures: Small tears in the anal lining, often caused by hard stool, constipation, or diarrhea. They may cause sharp pain or burning during or after a bowel movement.
- Constipation or straining: Hard stools and straining can irritate hemorrhoids or cause small tears.
- Diverticular bleeding: Bleeding from small pouches in the colon, which can sometimes be sudden or heavy.
- Inflammation or infection: Conditions such as ulcerative colitis, Crohn’s disease, proctitis, or infectious colitis can cause bleeding, diarrhea, mucus, or abdominal pain.
- Polyps or cancer: Growths in the colon or rectum can bleed. Most rectal bleeding is not cancer, but bleeding should not be ignored, especially if it is new, persistent, or accompanied by other symptoms.
When to Seek Emergency Care
Call 911 or go to the emergency department if rectal bleeding is heavy or continuous, or if it occurs with symptoms such as fainting, confusion, dizziness when standing, rapid breathing, pale or clammy skin, severe abdominal pain, chest pain, shortness of breath, or very little urination.
When to Call Your Healthcare Provider
Contact your healthcare provider if you notice any rectal bleeding, even if you think it may be from hemorrhoids. Make an appointment promptly if bleeding lasts more than a day or two, comes back after stopping, is mixed with stool, is associated with abdominal pain or diarrhea, or occurs with unexplained weight loss, fatigue, weakness, a change in bowel habits, or a family history of colorectal cancer.
What Your Clinician May Ask
Your clinician may ask when the bleeding started, how much blood you saw, whether the blood was bright red, maroon, or black, whether it was on the toilet paper or mixed with stool, and whether you have pain, constipation, diarrhea, abdominal cramps, dizziness, weight loss, or changes in bowel habits. They may also ask about medications such as aspirin, blood thinners, or anti-inflammatory medicines.
Possible Tests
The evaluation depends on your symptoms, age, medical history, and exam findings. Testing may include a physical exam, rectal exam, stool testing, blood tests, anoscopy or sigmoidoscopy, colonoscopy, or imaging if bleeding is severe. A colonoscopy may be recommended to look for inflammation, diverticular disease, polyps, or cancer and to treat some sources of bleeding.
What You Can Do
- Do not ignore rectal bleeding or assume it is only hemorrhoids.
- Drink fluids and eat fiber-rich foods such as fruits, vegetables, beans, and whole grains to help prevent constipation.
- Avoid straining and sitting on the toilet for long periods.
- Stay physically active, if your clinician says it is safe for you.
- Tell your clinician about all medicines and supplements you take, especially blood thinners, aspirin, and anti-inflammatory medicines.
- Keep track of bleeding episodes, stool color, pain, bowel habit changes, and any associated symptoms.
Key Takeaway
Rectal bleeding is common, but it should always be discussed with a healthcare professional. Most causes are treatable, and early evaluation helps identify problems before they become more serious. If bleeding is heavy, continuous, or associated with symptoms such as dizziness, fainting, severe abdominal pain, or weakness, seek emergency care right away.
