Rectal bleeding generally refers to bleeding from the anus, rectum, or colon, which are all the last parts of the digestive tract. In most cases, bright red blood indicates bleeding in the lower colon or rectum, while dark red blood is a sign of bleeding in the small intestine or upper colon.
Looking down the toilet and seeing blood can be alarming. Your mind can go to many places when the alarm bells are ringing that something is wrong. It is often rectal bleeding. A symptom of many medical conditions, rectal bleeding can range from mild to a sign of serious illness such as colorectal cancer. If you have rectal bleeding, you may see blood in different ways - on your toilet paper while you wipe, in the water in the toilet bowl, or your poop. They can be different colors, ranging from bright red to dark brown to black.
The color of the blood you see can indicate where the bleeding is coming from:
Bright red blood usually means weak bleeding in the colon or rectum.
Dark red or brown blood may mean you need to bleed higher up in the colon or small intestine.
Melena (dark, tar-like stools) often indicates bleeding in the stomach, such as bleeding from ulcers.
Sometimes rectal bleeding is not visible to the naked eye and can only be seen under a microscope. This type of bleeding is usually found during a lab test of a stool sample.
Causes and Treatment:
A wide range of conditions and health factors can cause or worsen rectal bleeding.Some of the most common causes include:
Hemorrhoids are inflamed anal blood vessels and they are extremely common. They can develop on the outside or inside of the anus, appearing as small bumps that sometimes bleed during bowel movements or when wiping.
Hemorrhoids, also called piles, can affect anyone of any age but are associated with a few risk factors, including:
Chronic constipation and tension
Straining during a bowel movement or sitting on the toilet for too long
Low-fiber or unbalanced diet
Hemorrhoids generally respond well to over-the-counter creams and suppositories that contain hydrocortisone. Frequent warm baths, a diet high in fiber, and using stool softeners can also help reduce the discomfort of hemorrhoids.
If the initial treatments fail, a doctor may perform minor surgery to remove the hemorrhoids.
A fistula occurs when an abnormal opening or pocket develops between two nearby organs. Fistulas that appear between the anus and the rectum, or the anus and the skin, can cause a discharge of white fluid and blood.
Fistulas are sometimes treated with antibiotics, but they may require surgery if they progress.
Cracks occur when the tissue lining the anus, colon, or rectum is torn, causing rectal pain and bleeding.
Warm baths, a diet high in fiber, and stool softeners can all help reduce crack symptoms. In severe cases, the cracks may require prescription creams or surgery.
Diverticulosis occurs when small pockets called diverticula to develop on the walls of the colon around weakened muscle layers in the organ.
These pouches or diverticula are extremely common. Sometimes the diverticula can start to bleed, but the bleeding usually stops on its own.
Usually, these pockets do not cause symptoms or require treatment unless they are infected, that is when a condition called diverticulitis occurs.
Infected and inflamed diverticula are often painful and can cause rectal bleeding, usually a moderate rush of blood that flows for a few seconds.
Diverticulitis is treated with antibiotics and, if severe, surgery.
Proctitis or colitis:
Proctitis occurs when the tissues that make up the rectum become inflamed, often causing pain and bleeding.
Colitis occurs when the tissues lining the colon become inflamed. A type of colitis called ulcerative colitis can also cause ulcers, or open, progressive sores that are prone to bleeding.
Treatments for proctitis and colitis vary depending on the cause and range from antibiotics to surgery.
Common causes of proctitis and colitis include:
Certain conditions that cause digestive problems, such as irritable bowel syndrome (IBS) and Crohn's disease
Certain medications, such as blood thinners
Radiotherapy or chemotherapy
Decreased blood flow to the colon or rectum
A blockage in the colon or rectum
Bacterial infections can cause inflammation of the colon and stomach, causing diarrhea which may contain mucus and blood spots. Viral gastroenteritis usually does not cause bloody diarrhea.
Treatment for gastroenteritis usually involves fluids, rest, and antibiotics or antivirals, depending on the cause.
Sexually transmitted infections (STIs):
Unprotected sex that involves the anal area can spread a wide range of viral and bacterial diseases. These can cause inflammation of the anus and rectum. Inflammation, if it occurs, increases the likelihood of bleeding.
Treatment for STIs usually involves antibiotic, antiviral, or antifungal medication, depending on whether the cause is bacterial, viral, or fungal.
Weakened rectal tissue can allow part of the rectum to push forward or swell outside the anus, usually causing pain and, almost always, bleeding.
Prolapse is more common in older people than in young people. Some people with this condition may require surgery to correct it.
Polyps are abnormal, non-cancerous growths. When polyps grow on the lining of the rectum or colon, they can cause irritation, inflammation, and minor bleeding.
In many cases, a doctor will remove the polyps so that they can be tested for signs of cancer and to prevent them from becoming cancerous.
Colon or rectal cancer:
Cancer that affects the colon or rectum can cause irritation, inflammation, and bleeding. Up to 48 percent of people with colorectal cancer have had rectal bleeding.
Colon cancer is a very common form of cancer and tends to grow slowly, so it's often treatable if caught early
Rectal cancer, although much rarer than colon cancer, is also usually curable if caught and treated in time.
Some cases of colon and rectal cancer develop from initially benign polyps. All cases of gastrointestinal cancer require treatment, which usually involves a combination of chemotherapy, radiation therapy, and surgery.
Serious injury to any of the gastrointestinal organs can lead to internal bleeding that passes through the rectum. Severe gastrointestinal illness can also lead to internal bleeding.
Internal bleeding almost always requires hospitalization and surgery.
Several tests allow a provider to examine the inside of the colon, rectum, and anus. These procedures are performed using specialized instruments called oscilloscopes:
Sigmoidoscopy: During a sigmoidoscopy, a clinician may examine the rectum and most of the lower large intestine.
Colonoscopy: A colonoscopy is a procedure in which a clinician examines the entire colon.
While the recommended tests may be different for different people, the important thing is to see a health care provider for an evaluation. This is the only way to know for sure the cause of your rectal bleeding and to get the care and treatment you need.
Treatments for rectal bleeding depend on the cause and the severity.
You can relieve the pain and discomfort of hemorrhoids by taking hot baths. Applying over-the-counter or prescription creams can also reduce irritation.
Your doctor may perform more invasive treatments if your hemorrhoid pain is severe or if the hemorrhoids are very large. These include rubber band ligation, laser treatments, and the surgical removal of hemorrhoids.
Like hemorrhoids, anal fissures can resolve on their own. Using stool softeners can solve constipation issues and help heal anal fissures. Infections may require antibiotic therapy to kill bacteria.
Colon cancers may require more invasive and long-term treatments, such as surgery, chemotherapy, and radiation therapy, to rule out cancer and reduce the risk of recurrence.
When to visit a Doctor:
Seek emergency help if you have significant rectal bleeding and any signs of shock:
Rapid, shallow breathing
Dizziness or lightheadedness after standing up
Cold, clammy, pale skin
Low urine output
These are some preventions for reducing rectal bleeding:
Most anal fissures heal with home treatment after a few days or weeks. These are called short-term (acute) anal fissures. If you have an anal fissure that has not healed after 8 to 12 weeks, it is considered a long-term (chronic) fissure. A chronic fissure may require medical treatment.
Rectal bleeding is usually not an emergency, but there are times when people need to see a doctor right away. Do this if you have blood in your stool and have any of these other signs: sweating or cold, clammy skin. Severe abdominal pain or cramps.