Rectal Bleeding

Overview

What is rectal bleeding?

Looking down into a toilet and seeing blood can be alarming. Your mind might go to many places as alarm bells ring that something is wrong. This is often rectal bleeding. A symptom of many different medical conditions, rectal bleeding can vary from being mild to being a sign of a serious condition like colorectal cancer. If you’re experiencing rectal bleeding, you might see blood in a few different ways — on your toilet paper as you wipe, in the water of the toilet bowl or in your poop. It can be different colors, ranging from bright red to a dark maroon to black.

The color of blood you see can actually indicate where the bleeding might be coming from.

  • Bright red blood usually means bleeding that’s low in your colon or rectum.
  • Dark red or maroon blood can mean that you have bleeding higher in the colon or in the small bowel.
  • Melena (dark and tar-like stool) often points to bleeding in the stomach, such as bleeding from ulcers.

Sometimes, rectal bleeding isn’t visible to the naked eye and can only be seen through a microscope. This type of bleeding is usually found during a lab test of a stool sample.

Is rectal bleeding serious?

In some cases, rectal bleeding can be a minor symptom of a condition that can be easily treated. Hemorrhoids, for example, can cause you to experience rectal bleeding. This usually doesn’t last long and hemorrhoids are often easy to treat. However, rectal bleeding can sometimes be a sign of a serious condition like colorectal cancer. It’s important to keep track of any bleeding you are experiencing. If it’s heavy, frequent or causing you to worry, call your healthcare provider to check it out.

How does rectal bleeding appear?

You might see or experience rectal bleeding in a few different ways, including:

  • Seeing blood on your toilet paper when you wipe.
  • Seeing blood in the bowl of the toilet when you are using the bathroom — the water in the bowl might look like it’s been dyed red.
  • Noticing dark red, black or tarry poop while you are having a bowel movement.

Rectal bleeding can be bright red or darker in color. You can also have rectal bleeding without being able to see it. This can happen when you have very small amounts of blood in your stool — called occult bleeding.

How would my stool look if I had rectal bleeding?

When you have blood in your stool it can look a few different ways. You may have bright red streaks of blood on your poop or you could see blood mixed in with it. Stool could also look very dark, almost black, and tarry.

Sometimes, you can have blood in your stool that’s not visible. This is called occult bleeding. This can be a sign of bleeding inside your digestive tract. It can also signal a more serious condition like an inflammation disease in your intestines or cancer. Occult bleeding is usually found during lab tests that look at a sample of your poop to check for small amounts of blood. This is called a fecal occult blood test and it can be used as a way to screen for possible colorectal cancer. Your healthcare provider might recommend this if you have a family history of colorectal cancer.

One thing to keep in mind when you see an unusual color in your poop is what you ate. There are certain foods that can change the color of your stool and make it look red or even black. This is often mistaken for blood in your stool.

What are the symptoms of rectal bleeding?

The symptoms of rectal bleeding can vary depending on what is causing the bleeding. Most causes of rectal bleeding are treatable and not serious. In some cases, rectal bleeding can be a symptom of a serious disease, such as colorectal cancer. Because it can be hard to know the cause of your rectal bleeding at home, it’s usually a good idea to reach out to your healthcare provider if you have rectal bleeding.

Some symptoms you might have with rectal bleeding can include:

  • Feeling rectal pain and/or pressure.
  • Seeing bright red blood in or on your stool, underwear, toilet paper or in the toilet bowl.
  • Having stool that’s red, maroon or black in color.
  • Having stool that has a tar-like appearance.
  • Experiencing mental confusion.
  • Feeling lightheaded or dizzy.
  • Fainting.

In some very severe cases, rectal bleeding can lead to shock. If you experience any symptoms of shock, call 911 right away and get help. The symptoms of shock can include:

  • Experiencing a sudden drop in your blood pressure.
  • Having a fast heart rate.
  • Not being able to urinate.
  • Slipping into unconsciousness.

Possible Causes

What causes rectal bleeding?

There are many different reasons why you might experience rectal bleeding. The causes of rectal bleeding can vary from common and mild conditions to more severe and rare conditions that need immediate medical treatment.

Causes of rectal bleeding can include:

  • Hemorrhoids: The most common cause of rectal bleeding, hemorrhoids are swollen veins in the rectum (internal hemorrhoids) or the anus (external hemorrhoids). You can develop hemorrhoids for many reasons, including chronic constipation, straining during bowel movements, pregnancy, lifting heavy objects, having anal intercourse and having a higher body weight (obesity). Hemorrhoids aren’t a medical emergency and the blood you may see on your toilet paper or in the toilet bowel isn’t something to be majorly concerned about.
  • Anal fissure: Sometimes confused for a hemorrhoid, an anal fissure is a split or tear in the skin around the anus. This happens when you have very hard stool that’s difficult to pass. The extra pressure of the bowel movement causes the skin to split open. An anal fissure can cause you to see blood when you go to the bathroom, as well as feel burning during bowel movements. Anal fissures usually go away on their own over time.
  • Anal abscess or fistula: There are actually small glands inside your anus that are meant to help you pass stool. These glands can become infected causing abscesses or fistulas. When the gland inside the anus builds up puss, causing a blockage, it’s an abscess. An anal fistula is a tiny tunnel that connects the abscess to the skin around the anus. These conditions can be caused by inflammatory bowel disease, tuberculosis or radiation treatments.
  • Diverticulosis/Diverticulitis: These conditions happen when small pouches — called diverticuli — develop in weakened sections of your intestine. These diverticuli can protrude through the walls of your bowels, causing bleeding and infections. When these pouches get infected, they can cause symptoms like abdominal pain, fever and a sudden change in bowel habits.
  • Inflammatory bowel disease (IBD): Inflammatory bowel disease (IBD) is swelling of the small or large intestine. There are two types of IBD — crohn's disease and colitis. Crohn’s disease is a condition where you develop patches of swelling in the digestive tract. In colitis, the swelling is mainly in the large bowel. People with IBD might experience fever, diarrhea, abdominal pain and cramping, intestinal blockages, and rectal bleeding.
  • Ulcers: When the amount of digestive fluids in your intestines is out of balance, it can damage the lining of your digestive tract and cause ulcers. These can bleed, causing you to have black stool that’s sometimes tar-like in appearance.
  • Large polyps: A polyp can look like a mushroom that’s growing out of the side of your bowel. Large polyps can bleed, causing you to experience rectal bleeding. In some cases, polyps can turn into cancer if left untreated. It’s important to have rectal bleeding related to polyps checked because it could be a sign of colorectal cancer.

Are there any foods that can change the color of my stool in a similar way to rectal bleeding?

There are certain foods that can make your poop an unusual color. You can have green, yellow and even black stool. This can happen for a variety of reasons – having too much bile during digestion, having a medical condition like inflammatory bowel disease or celiac disease, being on antibiotics, or even just eating foods with strong color pigments.

Often, blood can make your stool look very dark and almost black. Foods like black licorice, beets, dark berries (blueberries and blackberries) and red gelatin can all make your poop look very dark. This can easily be confused for blood in your stool. If you notice very dark poop during a bowel movement, think back to what you ate recently. There’s a chance that what you ate could be the cause for the usually dark stool.

Can straining too hard for a bowel movement cause rectal bleeding?

Straining too hard during a bowel movement can cause rectal bleeding. This is often related to constipation. When you strain, you can cause conditions like hemorrhoids or anal fissures. Very hard stool can actually cause the skin around your anus to tear, causing you to see blood. Treating constipation can help prevent this from happening.

Care and Treatment

Are there any tests for rectal bleeding?

There are several ways your healthcare provider can evaluate rectal bleeding to help figure out the cause. Your provider might start by asking you about the situation around your rectal bleeding. Some questions may include:

  • When did the rectal bleeding start?
  • What did you eat the day before seeing the rectal bleeding?
  • How frequently do you have a bowel movement?
  • Have you been constipated?
  • Were you straining during your bowel movement?
  • Do you have pain when you have the rectal bleeding?
  • Is there blood on your stool (and what does that look like), in the toilet bowel or when you wipe?
  • Do you have hemorrhoids?
  • Do you have any inflammatory bowel conditions?
  • Do you have a family history of colorectal cancer?

These questions can help your healthcare provider narrow down a possible cause of your bleeding. There are also tests that your provider can do to help determine the cause.

Tests to help diagnose the cause of rectal bleeding can include:

  • A physical exam of the rectum and anus.
  • A colonoscopy.
  • A sigmoidoscopy.
  • A fecal occult blood test (a Hemoccult® is a version of this test that can be done in your provider’s office).

Your healthcare provider may suggest only one of these tests, or do several of them together to try and discover the cause of your rectal bleeding.

Is bright red blood in my stool worse than darker blood?

The longer the blood is in your digestive tract, the darker it will typically look. This is because there are digestive chemicals in your body that naturally break down everything that moves through your digestive tract. The blood gets darker the longer it’s in contact with these chemicals. If your bleeding is higher up in the digestive tract, it might appear darker in the toilet. If you see bright red blood, that can mean it’s lower in your digestive tract or is moving through your body very quickly. While there are many benign (not harmful) causes of bright red bleeding, there are fewer benign causes of darker blood — for this reason, dark blood may be more concerning, and warrants workup by your healthcare provider.

How do I treat rectal bleeding?

In most cases, rectal bleeding can be treated by caring for the cause of the bleeding. Rectal bleeding is often a part of a bigger issue that needs to be taken care of. Once that condition has been treated, the bleeding usually stops. Treatment options can vary depending on the condition. Conditions like anal fissures can go away on their own over time or be treated with ointments. Hemorrhoids are another common cause of rectal bleeding that can be treated by either resolving any constipation issues, changing your diet and water intake, or possibly having surgery.

One more severe cause of rectal bleeding can be cancer. If this is the case, your healthcare provider will develop a treatment plan to treat the cancer, often removing any tumors.

Will rectal bleeding go away on its own?

Depending on the cause of the bleeding, your rectal bleeding can actually stop on its own. However, you need to pay attention to your body and keep track of the bleeding. If it happens one time and then stops, take note of it, but it most likely isn’t an emergency. If you have heavy rectal bleeding or are regularly seeing blood, reach out to your healthcare provider to get immediate care. It’s always a good idea to let your healthcare provider know about any rectal bleeding you have experienced.

When to Call the Doctor

When do I need to see a doctor about rectal bleeding?

It’s usually a good idea to reach out to your healthcare provider whenever you have rectal bleeding. It can be a sign of another health condition that might need treatment. If you have heavy bleeding or are seeing blood in multiple bowel movements, it’s urgent that you see your provider. Rectal bleeding can have serious causes that need to be treated.

What questions should I ask my doctor about rectal bleeding during an appointment?

If you’re experiencing rectal bleeding, calling your healthcare provider and going in for an appointment is often a good idea. Your provider will figure out what’s causing the bleeding and develop a plan to stop the bleeding.

It’s important to ask any questions you might have during this appointment. Don’t be embarrassed to talk about your bowel movements or details about your poop. This information might seem disgusting, but it will help your provider know what’s happening and find the best way to help you feel better.

Last reviewed by a Cleveland Clinic medical professional on 08/13/2020.

References

  • American Society for Gastrointestinal Endoscopy. . Accessed 8/13/2020. Understanding Minor Rectal Bleeding (https://www.asge.org/home/for-patients/patient-information/understanding-minor-rectal-bleeding)
  • Merck Manual Consumer Version. . Accessed 8/13/2020. Polyps of the Colon and Rectum (https://www.merckmanuals.com/home/digestive-disorders/tumors-of-the-digestive-system/polyps-of-the-colon-and-rectum)
  • Centers for Disease Control and Prevention. Accessed 8/13/2020. Inflammatory Bowel Disease (IBD): What Is It? (https://www.cdc.gov/features/inflammatory-bowel-disease/index.html)
  • Diet vs. Disease. Accessed 8/13/2020. Black, Green or Bloody: What’s Up With My Poop? (https://www.dietvsdisease.org/poop-stool-color/)
  • Canadian Society of Intestinal Research. . Accessed 8/13/2020. The Scoop on Poop: 7 Answers to Common Questions (https://badgut.org/information-centre/a-z-digestive-topics/the-scoop-on-poop/)
  • Colon Cancer Coalition. . Accessed 8/13/2020. Colon Cancer Symptoms (https://coloncancercoalition.org/get-educated/what-you-need-to-know/colon-cancer-symptoms/)
  • US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. . Accessed 8/13/2020. Gastrointestinal (GI) Bleeding (https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding)
  • Merck Manual Professional Version. . Accessed 8/13/2020.Overview of Gastrointestinal Bleeding (https://www.merckmanuals.com/professional/gastrointestinal-disorders/gastrointestinal-bleeding/overview-of-gastrointestinal-bleeding)

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