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What Causes Rectal Bleeding & How to Treat It

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Last updated February 18, 2021

Rectal bleeding quiz

Take a quiz to find out what's causing your rectal bleeding.

If you notice bright, red blood right after a bowel movement, you may have rectal bleeding. A bleeding rectum can be commonly caused by anal fissures, hemorrhoids, or chronic constipation.

8 most common causes

Rectal bleeding quiz

Take a quiz to find out what's causing your rectal bleeding.

Take rectal bleeding quiz

Rectal bleeding symptoms

It may be shocking to notice bright red blood in the toilet bowl or on the toilet tissue; however, rectal bleeding is more common than you think. Some causes are serious, but most of the time the bleeding is not dangerous and can be treated.

Common characteristics of rectal bleeding

If you're experiencing rectal bleeding, it can likely be described by:

  • Bright red blood coming from the rectum: This most commonly appears during a bowel movement or right after.
  • Pressure or discomfort in the rectum
  • Black or maroon stools: If the blood is coming from higher up in the intestine contained within the stools, the stools will appear black or maroon in color.

Duration of symptoms

Rectal bleeding may be acute or chronic depending on the cause.

  • Acute: An acute episode of rectal bleeding is one that occurs suddenly. A large amount of blood may be present.
  • Chronic: Chronic rectal bleeding may happen on and off for months or years, with only a small amount of blood present.

Who is most often affected by rectal bleeding?

Adults over age 40 are probably most often affected. Children can also experience rectal bleeding especially with severe and chronic constipation or diarrhea.

When is rectal bleeding most likely to occur?

Rectal bleeding often begins with chronic constipation from the straining and pressure on the walls of the rectum. Bleeding may also occur when there is chronic diarrhea because of irritation and inflammation of tissues.

Is rectal bleeding serious?

The severity of rectal bleeding is ultimately dependent on the cause.

  • Not serious: Occasional blood, especially in the presence of hemorrhoids and/or constipation, is most likely not serious.
  • Potentially serious: If there is rectal pain or bleeding that become chronic, especially with other symptoms of intestinal illness, you should see your medical provider for treatment.

9 causes of rectal bleeding

Many conditions can have rectal bleeding as a symptom. The most common are those involving constipation and hemorrhoids. However, bowel diseases, sexual activity, sexually transmitted infections, and tumors of the rectum or anus can also cause bleeding.

Most common causes

The most common causes of rectal bleeding include the following.

  • Anal fissures: Fissures are tearing and bleeding of the rectal or anal tissue.
  • Hemorrhoids: These are swollen veins either inside the rectum or beneath the outer skin of the anus. These enlarged veins can bleed easily under additional pressure, such as when you are having a bowel movement.

Less common causes

The following are less likely to cause rectal bleeding.

  • Bowel diseases: Many cause irritation and inflammation of the lining of the intestines.
  • Polyps: These are benign growths in the wall of the intestine and can become malignant if not removed.
  • Sexual activity of any kind that causes trauma to the anus and/or rectum: This includes infection with sexually transmitted diseases that damage these tissues.

Rare and unusual causes

The following are more rare, although possible, causes of rectal bleeding.

  • Rectal ulcers: These are sores within the lining of the rectum. These are most often due to chronic, ongoing constipation and the subsequent straining.
  • Proctitis: This is inflammation of the lining of the rectum.
  • Colon, rectal, or anal tumors: As well as the radiation therapy that may be used to treat them.

New onset crohn's disease

Crohn's disease is an inflammation of the bowel. It is caused by a faulty immune system response which makes the body attack the lining of the intestines.

The disease usually appears before age thirty and can affect anyone. Those with a family history may be most susceptible. Smoking is a known risk factor.

Aggravating factors include stress, poor diet, and nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin.

Early symptoms usually develop gradually, but can appear suddenly. These include fatigue, loss of appetite, fever, mouth sores, diarrhea, abdominal pain, and blood in stool.

Untreated Crohn's disease can cause ulcers throughout the digestive tract as well as bowel obstruction, malnutrition, and deteriorating general health.

Diagnosis is made through blood test and stool sample test. Colonoscopy, CT scan, MRI, endoscopy, and/or enteroscopy may also be used.

Crohn's disease cannot be cured, but can be managed through reducing the inflammation. Antibiotics, corticosteroids, and immune system suppressors may be tried. Excellent nutrition, vitamin supplements, smoking cessation, and reduction in stress can be helpful.

Rarity: Rare

Top Symptoms: fatigue, stomach bloating, loss of appetite, constipation, abdominal cramps (stomach cramps)

Urgency: Primary care doctor

Rectal bleeding quiz

Take a quiz to find out what's causing your rectal bleeding.

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Lower gastrointestinal bleeding

The digestive, or gastrointestinal (GI), tract includes the esophagus, stomach, small intestine, large intestine, rectum, and anus. Lower gastrointestinal bleeding refers to internal bleeding from the large intestine, rectum, or anus, usually caused by hemorrhoids, ischemic bowel disease, or inflammatory bowel disease.

Call 911 immediately for an ambulance now if the bleeding is severe. Otherwise, you should seek immediate medical care at an urgent care clinic or ER. A medical team will evaluate this critical condition and determine if surgical intervention is needed to stop the bleeding.

Rarity: Rare

Top Symptoms: rectal bleeding, severe rectal bleeding, moderate rectal bleeding

Urgency: Emergency medical service

Intestinal inflammation (diverticulitis)

When the passage of food through the colon becomes sluggish, the food can stagnate, increase in bulk, create pressure, and cause diverticula – or pouches – to form in the walls of the large intestine. If these pouches become inflamed, the condition is called diverticulitis.

Risk factors are a low-fiber diet, smoking, obesity, chronic constipation, and lack of "good" bacteria in the gut.

Patients over 50, with a previous history of inflammatory disease of the colon, are most susceptible.

Symptoms include persistent abdominal pain; fever; nausea and vomiting; and constipation sometimes alternating with diarrhea.

Left untreated, diverticulitis can lead to intestinal blockage and scarring. Rupture of an inflamed pouch can result, leading to peritonitis. These are medical emergencies. If suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made by ruling out other conditions through physical examination; blood, urine, and stool tests; and CT scan.

Less serious cases are treated with a high-fiber diet, fluids, probiotics, antibiotics, and lifestyle management. Others may require intravenous antibiotics and/or surgery.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation

Symptoms that never occur with intestinal inflammation (diverticulitis): pain below the ribs, pain in the upper right abdomen

Urgency: Hospital emergency room

Hemorrhoids

Hemorrhoids, or "piles," are swollen veins in the anus or rectum. They may be located inside the rectum (internal) or outside the body at the anus (external.)

The condition is caused by straining during bowel movements and/or from increased pressure during pregnancy and childbirth.

Hemorrhoids are a common occurrence, especially in older people. Pregnant women are susceptible, as is anyone who has chronic constipation or is obese.

Symptoms include discomfort, pain, pressure, and itching. There may be small amounts of bleeding during bowel movements, though some hemorrhoids cause no symptoms at all.

Severe pain can indicate a thrombosed hemorrhoid, meaning a clot has formed within it. This is not serious but the pain can be debilitating and requires treatment right away. Also, rectal bleeding can also be a sign of more serious diseases such as diverticulitis or cancer and should always be diagnosed by a medical provider.

Diagnosis is made through physical examination and sometimes through colonoscopy.

Treatment begins with good hygiene, cold compresses, and over-the-counter pain relievers. Surgery may be done for some cases.

Diverticulosis

Diverticulosis is the common condition of having small pouches form, and push outward, along the inside of the colon.

Causes are believed to be family history, smoking, obesity, sedentary lifestyle, and some medications such as nonsteroidal anti-inflammatory drugs.

Most susceptible are women over the age of 60, though anyone can be affected.

Diverticulosis often has few or no symptoms, but there may be changes in bowel movement patterns; abdominal pain; bloating; constipation; diarrhea; or rectal bleeding.

These symptoms should be seen by a medical provider, since diverticulosis can lead to diverticulitis – an inflammation of the pouches that can have serious complications. Also, the symptoms of are similar to those of inflammatory bowel disease and so a definite diagnosis should be made.

Diagnosis is made through patient history; physical examination, which may include a rectal exam; blood tests; and CT scan. In some cases, a colonoscopy will be done.

Treatment involves a high-fiber diet; medicines to ease bloating and other symptoms; and sometimes antibiotics.

Colonic neoplasm

Colonic neoplasm means "new tissue" growing in the colon, or large intestine. This neoplasm may be either benign (not cancerous) or malignant (cancer.)

The exact cause of any cancer remains unknown. Risk factors seem to be:

  • Being over fifty years of age.
  • Family history of the disease.
  • A high-fat, low-fiber diet, typical in the modern world
  • Chronic inflammatory diseases of the colon such as Crohn's disease.
  • Smoking and alcohol use.
  • Diabetes, obesity, and inactivity.

The earliest symptoms are usually polyps, small growths within the colon which can be detected on colonoscopy and removed before they can become cancerous. Later symptoms may be unexplained fatigue; change in bowel habits; persistent abdominal discomfort such as gas or cramps; blood in stool; or rectal bleeding.

Diagnosis is made through colonoscopy and sometimes blood testing.

Treatment is done through surgery, which may be minor or extensive; and through chemotherapy with radiation therapy, usually done before and after surgery. Supportive care to keep the patient comfortable is also an important part of treatment.

Rarity: Rare

Top Symptoms: fatigue, stomach bloating, stool changes, diarrhea, constipation

Urgency: Primary care doctor

Chronic constipation

Constipation is a very common condition affecting the large intestine. It is characterized by difficulty passing stool, or passing stool less often. Commonly it is linked to not eating enough dietary fiber, not drinking enough fluids, or not getting enough exercise. Some medications can cause constipation as well.

Given how long your symptoms have lasted, you should go see your doctor to consider treatment for constipation. Typically, dietary changes like drinking more water and eating more fiber is good enough; however, over-the-counter and/or prescription medications to bulk up the stool or increase the movement of the bowels can also help when dietary changes aren't working.

Rarity: Common

Top Symptoms: stomach bloating, constipation, abdominal cramps (stomach cramps), pain when passing stools, rectal bleeding

Symptoms that always occur with chronic constipation: constipation

Symptoms that never occur with chronic constipation: unintentional weight loss

Urgency: Primary care doctor

Anal fissure

An anal fissure is a break, or tear, in the mucous membrane lining of the anus. The anus is the opening at the end of the digestive tract where stool leaves the body.

A fissure is caused primarily by constipation, which leads to straining to pass large hard stools; trauma caused by insertion of objects or by anal sex; and illnesses such as any type of inflammatory bowel disease or sexually transmitted disease.

Symptoms include pain and bleeding during and after a bowel movement; discomfort and difficulty with urination; and a visible tear, resembling a crack, in the anal tissue that may have a foul-smelling discharge.

Diagnosis is made through physical examination.

Treatment primarily involves relieving constipation, and the straining it causes, by adding fiber and more fluids to the diet; and easing anal irritation by soaking in a warm bath and gently cleansing the tissues of the anus. In some cases, medicated creams or suppositories may be prescribed.

Rectal bleeding quiz

Take a quiz to find out what's causing your rectal bleeding.

Take rectal bleeding quiz

Chronic or recurrent hemorrhoids

Chronic, or recurrent, hemorrhoids are swollen veins in the anus and rectum that never really resolve and may be symptomatic more or less constantly.

Hemorrhoids are caused by anything that puts pressure on the anus from the inside, such as straining during bowel movements; constipation; pregnancy; or anal intercourse.

Most susceptible are pregnant women and older people, though anyone can be affected.

Symptoms include a small amount of bleeding during or after a bowel movement, as well as discomfort, itching, or swelling around the anus.

A medical provider can suggest treatment to ease the symptoms of chronic hemorrhoids, as well as make certain of the diagnosis since other, more serious conditions can have symptoms similar to hemorrhoids.

Diagnosis is made through patient history and physical examination.

Treatment most often involves simple lifestyle changes such as drinking more water; adding fiber-rich foods to the diet; using fiber supplements and stool softeners; not delaying, or straining, to pass a bowel movement; and using topical medications. Surgical procedures to remove the hemorrhoid can be used in some cases.

Rarity: Common

Top Symptoms: rectal bleeding, rectal pain, pain when passing stools, anal itching, painless rectal bleeding

Symptoms that never occur with chronic or recurrent hemorrhoids: unintentional weight loss

Urgency: Self-treatment

Rectal bleeding treatments and relief

When rectal bleeding is an emergency

Seek immediate treatment in the emergency room or call 911 if:

  • A significant amount of blood suddenly appears from the rectum: Whether this happens during a bowel movement or not
  • You also have severe abdominal pain or cramping
  • You feel cold, nauseated, dizzy, lightheaded, or actually faint while symptoms of rectal bleeding are occurring: This may indicate that a large amount of blood is being lost internally.

When to see a doctor for rectal bleeding

You should schedule an appointment for:

  • Rectal bleeding that happens on a regular basis: Even if there seems to be only a small amount of blood.
  • Stools that appear tarry, black, or maroon: These colors indicate larger amounts of blood.
  • Bleeding that occurs on its own and not while you are having a bowel movement
  • Ongoing pain in the anus and rectum: Often with mucus discharge

At-home treatments for rectal bleeding

For mild or occasional cases of rectal bleeding, you can try the following at home:

  • Easing constipation and promoting regularity: This can be achieved through improved diet and exercise, drinking more water, and taking an over-the-counter fiber supplement.
  • Trying warm baths and over-the-counter hydrocortisone cream for hemorrhoids

FAQs about rectal bleeding

Does rectal bleeding stop on its own?

Rectal bleeding (hematochezia) may stop on its own depending on the cause. Hemorrhoids or injury of the anus, like an anal tear, will usually stop bleeding on their own. If you have rectal bleeding that has not been examined by a medical professional, you should seek treatment.

Can rectal bleeding cause anemia?

Yes, bleeding from the rectum (hematochezia) can cause anemia if it is uncontrolled. The most common causes are hemorrhoids and anal fissures, but cirrhosis or liver failure from alcohol can also increase the risk of bleeds as well as diverticulosis (an outpouching of the colon).

Can rectal bleeding be caused by stress?

Generally no, rectal bleeding (hematochezia) is not caused by stress. Stomach ulcers can be caused by stress, but the enzymes and hormones that cause a stomach ulcer do not affect the rectum similarly. If you are experiencing rectal bleeding you should seek medical care.

Why does rectal bleeding occur after a bowel movement?

Rectal bleeding (hematochezia) may occur after a particularly large or hard bowel movement from an anal tear or anal fissure. Less commonly, stool that has an abrasive substance like nuts or undigested whole grains can tear the anal mucosa and cause bright red blood on the toilet paper or in the bowl.

Why does my rectal bleeding come and go?

Rectal bleeding (hematochezia) can come and go for a variety of reasons. It can be caused by hemorrhoids as well as anal fissures, certain types of inflammatory bowel disease, changes in the rectum, and cancers. Most of these causes can produce intermittent bleeding so you should seek medical evaluation to determine the cause. Intermittent bleeding is often caused by clotting or blockage of a bleed with firm stool.

Questions your doctor may ask about rectal bleeding

To diagnose this condition, your doctor would likely ask the following questions:

  • Have you had any changes in your weight?
  • Do you have a history of constipation?
  • Is your bleeding painful or painless?
  • Have you ever been diagnosed with cancer?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Hear what 1 other is saying
Blood on toilet paperPosted January 24, 2021 by A.
Every so often, when I go to move my bowels, when I wipe to clean myself I notice that there's blood on the toilet paper. The only conclusion I can come up with is that I might've irritated my hemorrhoids. I definitely need to stay away from the hot spices I put in my food while cooking. I'm going to share this with my primary care physician. I've had 2 colonoscopies and the test results came back normal, but it's been 4 years since my last one so I'm going to ask my PCP to schedule me for another one. These are the precautionary steps I suggest anyone should take if they have the same or similar experience.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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