What Causes Rectal Bleeding & How to Treat It
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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.
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?
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.
Hemorrhoids, also known as piles, are swollen veins in your anus and lower rectum that can cause pain, itching, and rectal bleeding. Hemorrhoids may be seen or felt on the outside of the anus (external) or may be hidden from view inside of the rectum.
Hemorrhoids are common occurring in 10 million Am...
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.
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
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 objec...
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.
Top Symptoms: rectal bleeding, severe rectal bleeding, moderate rectal bleeding
Urgency: Emergency medical service
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.
Top Symptoms: fatigue, stomach bloating, stool changes, diarrhea, constipation
Urgency: Primary care doctor
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.
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
Intestinal inflammation (diverticulitis)
Diverticula are small pouches that bulge outward through the colon, or large intestine. Diverticulitis is a condition where the pouches become inflamed or infected, a process which can cause fever, nausea, vomiting, chills, cramping, and constipation.
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
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.
Top Symptoms: fatigue, stomach bloating, loss of appetite, constipation, abdominal cramps (stomach cramps)
Urgency: Primary care doctor
Diverticulosis is the common condition of small, sac-like pouches forming and pushing outward along the inside of the colon, called diverticula. With diverticulosis, there may be changes in bowel movement patterns as well as severe abdominal pain, bloating, constipation, diarrhea, or rectal bl...
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.
Janeen has worked over eight years as a full-time medical transcriptionist, specializing in pain management and gynecologic oncology. She later began transcribing reports for hospital emergency rooms and acute care admissions. This background gave her a strong medical vocabulary as well as a heart for making medical information accessible to the average person, leading her to work as a medical writer. She began as a pre-veterinary medicine major at Texas State University.
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