One of the most common reasons patients come to see me is for blood in stool or rectal bleeding. Seeing blood in the toilet or on toilet paper is very alarming, but also very common. Although it is never normal, most of the causes of rectal bleeding are not life-threatening and can be easily treated. However, it is not possible to know the cause of the bleeding without being examined. Thus, ANYONE who sees blood should talk with their doctor to figure out the cause. Blood after a bowel movement is a really common problem and it is estimated that over 14% of the US population has experienced this at some point in their lives. Below, I will review what to do when you see blood.
You see blood in stool or on toilet paper after a bowel movement. What now?
First, take note of HOW MUCH blood there is. If it is a significant amount, this could be an active bleeding situation, which needs medical attention immediately. If there is a small amount of blood in the water or on the toilet paper, it could be a variety of treatable conditions which are described below.
What causes blood in stool?
There are lots of potential causes of blood in stool or rectal bleeding, but the most common ones are listed below.
Hemorrhoids
Hemorrhoids are swollen blood vessels in the rectum or anus that can be painful, itchy, and can sometimes bleed. Painless rectal bleeding with a bowel movement is a common symptom of hemorrhoids. Bright red blood typically coats the stool or blood may drip into the toilet or on the paper.
Anal fissure
An anal fissure is a tear in the lining of the anus. Anal fissures can cause bleeding and a sensation of tearing, ripping, or burning during or after a bowel movement.
Colon Cancer and Colon Polyps
Although not the most common cause of bleeding, colon cancer is still the second leading cause of cancer death in the United States. Unfortunately, colon cancer usually doesn’t present with any symptoms, but sometimes it presents as rectal bleeding and needs to be evaluated by your gastroenterologist.
Other causes of rectal bleeding
There are many other causes of rectal bleeding, including Colitis, Crohn’s disease, IBD, Proctitis, Angiodysplasia and Diverticulosis. All of which can be diagnosed with an examination. Bleeding may also come from higher in the digestive tract, such as the stomach. This produces black, tarry bowel movements due to stomach acid, which turns blood black. If the blood is dark red or includes clots, usually this indicates bleeding from higher in the colon.
Why should I worry about rectal bleeding?
While most rectal bleeding is caused by non-serious issues mentioned above, bleeding can also be caused by cancerous or precancerous conditions. Precancerous polyps near the end of the colon can mimic bleeding from hemorrhoids. These polyps are generally present in the colon for years before they become cancerous. They can be removed very safely from the colon, preventing progression to cancer. However, it is not uncommon for colon cancer to be diagnosed in patients who have ignored bleeding for years, assuming it was from hemorrhoids. Therefore, it is best to get checked out by your doctor if you have any rectal bleeding.
RECTAL BLEEDING TESTS
The best test for rectal bleeding depends upon your age, symptoms, and examination findings. If a direct cause is not found, then a colonoscopy should be performed in order to diagnose and treat the problem.
So, if you see blood in your stool, Do Not Panic. Most of the time, it is a simple problem to fix, but schedule an examination with your doctor in order to make sure. Whatever you do, Don’t Ignore It; contact your doctor.
UPDATE: The Internet can be a great resource for researching various health symptoms and available treatments. However, it should not be used to seek health advise or replace the care and expertise that a physician can offer. I’m posting this comment since I continually receive questions regarding the urgency people should use to see their doctor regarding their symptoms (e.g. rectal bleeding) or other medical advice. Those opinions will not be given on my blog and I would hope the same would be true for all other online medical channels moderated by a health care professional.
Kenneth Brown, M.D.
Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your healthcare provider to determine what is right for you. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition
Hello Doctor, Thanks for such a helpful information. I was diagnosed with Ulcerative Colitis last year in March 2012.(actually Ulcerative Proctitis as inflammation occured in the rectum and lower part of the colon). I was very panic at that time since these was happening to me first time and did not know about the terms such as colonoscopy, rectal bleeding etc. After browsing your website and reading such info, feel less panic, less scared. When you get chance, can you please post more information regarding treatment, medications of U.C or U.P. currently I am on U.C medications (Lialda (1.2 gm) and Azathioprine (50 mg)). symptoms has improved but not back to normal. So When you get chance, can you please post more information on treatment and medications and diet of U.C or U.P. Thank You.
hello doctor, today i have experienced first time ever blood in my stool. i waited about 20 mins to go washroom after i feel to go then when i went for washrooom i found blood into it, blood comes like there is small bleeding
As always I would suggest seeing your regular doctor to discuss this, but most often a small amount of blood is either from a hemorrhoid or fissure. That being said you should always get checked out by your doctor to make sure it is not something more serious.
Hello Dr, Very helpful article. I am currently on antibiotics (zpack) for respiratory infection. I also have had diarrhea for the last week, prior to antibiotics. This morning there was a considerable amount of blood in my stool x2. Is this possibly a side effect from having diarrhea so long?
When we have diarrhea, this can exacerbate hemorrhoids or a fissure, but the concern is why the diarrhea and now bleeding. Things like infectious colitis or ulcerative colitis can present like this as well. Bottom line is that I strongly suggest to see your doctor and have this evaluated as soon as possible.
Hello doctor,what should if bleeding is large and after a long interval of time
All bleeding is abnormal but when there is a significant amount, I recommend seeing your doctor as soon as possible. If it were to continue in a large amount then going to the nearest ER would be the most prudent thing to do.
Hi Doctor, i saw blood in the toilet and paper this morning. No pain. Later bowel movements without blood. This was the second time. The first one was around a month ago. Do i still need to see doctor if this doesnt happen again?
Regards
Hi Jim. Due to HIPAA guidelines I cannot provide specific medical advice online. My online commentary is strictly to be used as a guideline and point of reference on the digestive health topics that I cover. While I do welcome questions in regards to how the digestive system works, my recommendation will always be to speak directly with your physician should need you need advice on how to diagnose or treat a specific condition.
Dear Doctor, my blood in stool is dark red instead of fresh red. That really freaks me out. I have already scheduled with a GI specialist to check it out next week. But I am still so scared to get a cancer, because blood caused by Hemorrhoids and anal fissure tend to be fresh red instead of dark red. I am only 22…
Any blood in one’s stool can be an alarming experience at any age. While cancer is not common result of this symptom, I’m glad to see that you have scheduled an appointment with a gastroenterologist. The biggest mistake people make is not seeking medical treatment at the onset. Thank you for your comment and I hope everything turns out well for you. Sincerely – Kenneth Brown, M.D.
I had an colonoscopy about three weeks ago and I did not have polyps this time…I do have diverticulosis which I have had for many years bug has only flared up once….I also have hemorrhoids which tend to flare up often and it shows on the toilet paper each time….
The problem I have this time is I have blood in the toilet but before I saw that when I had wiped I notice blood mixed in with my BM…So I am kinda concerned what is your advice on this?
Hi Billie. I understand that finding blood in the toilet can be quite alarming. Typically it is not an indicator of a more serious condition. However, whenever blood is discovered in one’s stool you should make an appointment with your doctor or a gastroenterologist to ensure that the blood is not an indicator of another issue. I hope everything turns out ok. Sincerely – Kenneth Brown, M.D.