Rectal Bleeding

What is rectal bleeding?

Looking down into a toilet and seeing blood in your stool (poop) can be alarming. Your mind might go to many places as warning bells ring that something’s wrong. Rectal bleeding is a symptom of many different conditions, some more serious than others. It’s important to find out the cause of your rectal bleeding.

Some causes, like hemorrhoids, may not need treatment. But others, like colorectal cancer, need urgent care. Ulcers, anal fissures and inflammatory bowel disease (IBD) are other possible causes. A healthcare provider can help determine the cause of your hematochezia — the medical term for rectal bleeding or blood in your stool.

How does rectal bleeding appear?

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

• Noticing fresh blood on your toilet paper when you wipe.
• Seeing blood in the bowl of the toilet after you use the bathroom. The water in the bowl might look like it’s been dyed red.
• Seeing bright red, dark red or tarry black poop in the toilet.

When bleeding comes out from your anus (butthole), we call it rectal bleeding, but in fact, the bleeding could be coming from anywhere in your gastrointestinal (GI) tract. Your stomach, small intestine, colon, rectum and anus are all one continuous pathway, and all gastrointestinal bleeding comes out the same way.

What does blood in stool look like?

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 might see blood clots or blood and mucus mixed in with it. Your stool could also look dark, black and tarry. The color of the blood you see may be a clue to where it’s coming from:

• Bright red blood in your stool usually means the bleeding is lower in your colon, rectum or anus.
• Dark red or maroon blood can mean that you have bleeding higher up in your colon or your small intestine.
• Melena (black stool) often points to bleeding in your stomach, such as a bleeding stomach ulcer.

Sometimes, rectal bleeding isn’t visible to the naked eye and can only be seen through a microscope. This is called occult bleeding. You may discover this type of blood in your stool if you have a lab test done on a stool sample called a fecal occult blood test. It’s a screening test for colorectal cancer.

Is blood in your stool serious?

Not necessarily, but it could be. It’s a good idea to check with a healthcare provider any time you have rectal bleeding or blood in your stool. Some minor conditions might not need treatment, but sometimes they might. Rectal bleeding could also be a sign of a more serious condition that needs treatment.

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

Bright red blood in your stool might be more alarming because it suggests active bleeding. Darker blood usually suggests older bleeding that’s not active anymore. But darker blood in your stool can be deceiving. It doesn’t always mean the bleeding has stopped, only that it’s coming from someplace higher up.

Bleeding in your upper GI tract takes longer to travel through your body and out of your anus. As it travels, the digestive chemicals inside gradually turn it darker. Bright red blood comes from lower down. It could be from something relatively harmless, like a flesh wound. An upper GI bleed is less likely to be harmless.

When should you worry about blood in your stool?

It never hurts to check with a healthcare provider about blood in your stool, especially if:

• You don’t know why it’s happening. Sometimes, rectal bleeding relates to a condition that you already know you have. You might not be particularly surprised if you have bleeding when you have constipation, diarrhea or a chronic bowel disease. On the other hand, if blood in your stool is your first sign of any gastrointestinal disease, this is more surprising and concerning.
• It’s painful. Pain is always a red flag that something in your body needs attention. Notice where the pain is located. If it’s in your anus or rectum, it might be a fresh wound. If you feel pain in your lower abdomen, it might be colitis — inflammation in the lining of your colon, which has many causes. If you have upper abdominal pain and black stools, it might be your stomach.
• It’s heavy or frequent. Heavy or frequent bleeding is more likely to lead to serious blood loss, including anemia and, in rare cases, hypovolemic shock. If you have sudden severe bleeding, or if you’ve had consistent bleeding for several days, seek healthcare right away. If you have a sudden drop in blood pressure and feel lightheaded or like you’re fainting, go to the emergency room (ER).
• It’s been going on for a week or longer. Even if you’re not bleeding very much and you don’t feel any pain, rectal bleeding that’s gone on for some time needs treatment. A slow bleed can still lead to significant blood loss over time. More importantly, it’s a sign of a condition that isn’t improving. That condition may be doing other damage besides causing blood in your stool.

What causes rectal bleeding?

There are many different reasons why you might experience hematochezia — rectal bleeding or blood in your stool. These causes vary from common and mild conditions to more severe and rare conditions that need immediate medical attention. Sometimes other symptoms can offer clues to the possible cause.

Common causes of rectal bleeding include:

• Hemorrhoids: Hemorrhoids, or piles, are swollen veins inside your rectum or anus. They’re very common, and they’re the most common cause of rectal bleeding. These veins bulge close to the surface of the skin, and sometimes the skin breaks and they bleed. They’re not serious. They usually relate to straining or pressure, like from pregnancy, heavy lifting or straining to poop.
• Anal fissure: An anal fissure is a tear in the lining of your anal canal. Like a hemorrhoid, it often happens after straining to pass a hard stool. Anal fissures are easily mistaken for hemorrhoids. They both relate to constipation, and both can cause anal pain and bleeding. A fissure can be more painful. Both can heal on their own, but sometimes a fissure needs treatment to heal.
• Inflammatory bowel disease (IBD): Inflammatory bowel disease (IBD) causes chronic (ongoing) inflammation in the lining of your bowels — your small and large intestines. Crohn’s disease mostly affects your small intestine, while ulcerative colitis mostly affects your large intestine. IBD causes chronic abdominal pain and diarrhea and, when it’s severe, it can cause bleeding.
• Diverticulitis: Diverticulitis occurs in your colon, usually in the lower end, close to your rectum. It happens when little pockets in the inner lining of your colon — called diverticula — become infected and inflamed. Inflammation in these pockets can make the blood vessels inside more fragile and more likely to rupture. If this happens, it can cause acute rectal bleeding.

Other possible causes include:

• Infectious colitis: Some bacterial infections, like E. coli and C. diff, can cause hemorrhagic colitis — bleeding from your colon. This usually comes in the form of bloody diarrhea. You’ll know it if you’re sick with an infection, and most of the time, it resolves by itself. But some infections may need antibiotics. If you’re sick for more than a couple of days, call your healthcare provider.
• Sexually transmitted infections (STIs): Certain common STIs can cause inflammation and bleeding in your anal or rectal lining, including gonorrhea, chlamydia and syphilis. Herpes causes sores that may bleed and human papillomavirus (HPV) causes anal warts that may bleed a little. Many STIs need specific treatment to go away, so it’s important to get them diagnosed.
• Peptic ulcer disease: Peptic ulcers happen in your stomach or duodenum, the top of your small intestine. They happen when stomach acid wears away the protective lining, creating open sores. An ulcer causes a burning or gnawing kind of stomach pain, and it may bleed. Bleeding in your upper GI tract takes longer to come out, so the blood may be dark, black and tarry.
• Colon polyps and colorectal cancer: A polyp can look like a mushroom growing out of the side of your bowel. Polyps are common, and larger ones can bleed. Sometimes they turn into cancer, and cancerous polyps are more likely to bleed than others. Your healthcare provider may want to investigate unexplained rectal bleeding with a colonoscopy to rule out colon cancer.

Can straining too hard to poop cause rectal bleeding?

Yes, constipation and straining to poop can cause rectal bleeding. When you strain, you can cause conditions like hemorrhoids or anal fissures, which may bleed. Very hard stools may tear the skin inside your anus, causing bleeding. Treating your constipation can help prevent this from happening.

Are the causes of blood in stool the same for a baby or child?

Children and babies can get hemorrhoids and anal fissures, too, from straining to poop. Anal fissures are the most common cause of rectal bleeding in children. Children also get infectious colitis. They’re less likely to have chronic diseases, like IBD, diverticulitis or colon cancer, which take time to develop.

Are the causes of rectal bleeding the same for a man (AMAB) or a woman (AFAB)?

Most of the causes of rectal bleeding are the same for a man, woman or any gender. Women and people AFAB can also get endometriosis. Rarely, endometriosis may cause rectal bleeding if it spreads to your lower bowel or rectum. The tissue may become inflamed and bleed during your menstrual cycle.

Can foods cause the appearance of blood in your stool?

Certain foods can change the color of your poop. If you think you see blood in your stool, think back to what you recently ate. Beets, tomatoes, blackberries or red food coloring may look red or bloody when they come out in your poop. If you take iron supplements, these can make your stool look dark or black.

How do healthcare providers determine the cause of rectal bleeding?

There are several ways your healthcare provider can evaluate rectal bleeding or blood in your stool to figure out the cause. They might start by asking you questions about the circumstances surrounding your rectal bleeding or the blood in your stool. This can help narrow down the possible causes.

They might ask:

• When did your rectal bleeding start?
• Do you have pain with rectal bleeding or no pain?
• Do you see blood in your stool, or when you wipe?
• What does the blood in your stool look like? Are there streaks or clots?
• What did your stool look like? Was it runny or hard?
• Do you have diarrhea or constipation?
• Were you straining to poop when you saw blood in your stool?
• How frequently do you have a bowel movement?
• What did you eat the day before you noticed blood in your stool?
• What medications did you take the day before your rectal bleeding?
• Had you been drinking the day before your rectal bleeding?
• Do you have hemorrhoids?
• Do you have diverticulosis?
• Do you have inflammatory bowel disease?
• Do you have a family history of colorectal cancer?

Your answers to these questions can help your provider determine which medical tests to follow up with. Tests might include:

• Digital rectal exam. A physical examination of your rectum and anus.
• Anoscopy. An examination of your anal canal using a small scope with a magnifier.
• Proctoscopy. An examination of your rectum and anus using a short, rigid scope.
• Flexible sigmoidoscopy. An examination using a longer scope to see into your lower colon.
• Rectal culture swab. A bacterial culture to identify infections.
• Stool test. Healthcare providers may check a sample of your stool for evidence of active bleeding, occult blood or inflammation. They can also check for specific infections.
• Colonoscopy. An examination of your whole large intestine using a colonoscope, a lighted camera on the end of a long tube. A colonoscopy is a common screening test for colon cancer.
• Upper endoscopy. Your provider might suggest an upper endoscopy if they suspect an upper GI bleed. The endoscope passes down your throat into your stomach and duodenum.

What is the treatment for rectal bleeding?

In most cases, treating rectal bleeding means treating the disease that’s causing it. The treatment will depend on the cause, which could be many things. If your rectal bleeding is from an anal fissure or a hemorrhoid that you can reach, you might be able to help treat it at home with topical ointments.

Will rectal bleeding go away on its own?

Depending on the cause, your rectal bleeding may stop on its own. If it stops and doesn’t come back, it probably won’t need further treatment. But you should always keep an eye on any rectal bleeding or blood in your stool. Notice if it happens more than once, or if you have any other symptoms with it.

When should I see a doctor about rectal bleeding?

It’s a good idea to reach out to your healthcare provider whenever you have rectal bleeding. It can be a symptom of a larger condition that needs treatment. If you have heavy bleeding or large blood clots in your stool, seek urgent care. If your poop looks black and tarry, you might have an upper GI bleed.

What questions should I ask my doctor about rectal bleeding?

If you’re experiencing rectal bleeding, you and your healthcare provider will want to know why, and what to do about it. Your provider will work to determine the cause of your rectal bleeding and what kind of treatment you may need. As they go through their process, you might want to ask:

• Is my rectal bleeding related to a condition that I already know I have?
• Are there other signs or symptoms I should look out for?
• What tests will I need to have to diagnose the cause?
• What are my treatment options for this condition?
• How should I take care of myself when I have rectal bleeding?
• Can I help prevent future episodes by changing my diet, medications or habits?

A note from Cleveland Clinic

Bleeding evokes a special, primal kind of worry, especially when you can’t see where it’s coming from. It might feel hard to wait for a medical appointment to find out what your rectal bleeding means. Keep in mind, while there are many possible causes, the most common ones are easy to find and fix.

Don’t be embarrassed to talk to a healthcare provider about rectal bleeding or blood in your stool. These are important symptoms, and healthcare providers will want to know all about them. Answering their questions as fully and honestly as you can will help them determine the type of care you need.