Toilet paper rolling out with a purple background

Why is there Blood in my Stool? Rectal Bleeding

CDHF

Written by: CDHF

Updated: November 29th, 2022

Let’s face it – nobody likes seeing their own blood outside their body, especially from their bum or in their stool. Finishing up on the toilet and wiping only to find smears of red on the paper can be unsettling. Even more alarming is peeking into the bowl to find red stool (sometimes so dark that it appears completely black). While the presence of blood certainly needs to be addressed, there are several different potential reasons it could have happened – some more serious than others.

Most people with minor rectal bleeding don’t have colon cancer or another serious condition, so don’t immediately freak out! However, it is not possible to know the cause of bleeding without an examination by a physician. For this reason, if you ever notice blood in your stool or bleeding from your rectum, you should contact your health care provider as soon as possible. They can give you advice about whether and when you should be examined or schedule tests. Large amounts of blood should be dealt with immediately at the hospital.

You should also seek medical care if you notice a change in the frequency or consistency of your bowel movements, have abdominal pain, or feel very tired or weak.

Why is there blood when I wipe?

If you see a small amount of bright red blood on the toilet paper after wiping, on the outside of your stool, or in the toilet, this may be caused by hemorrhoids or an anal fissure. Both conditions are quite harmless, and there are treatments that can help (often as easy as applying a cream) (Huizen, 2020).

Why is my poop black/red?

Rectal bleeding usually refers to bleeding from the anus, rectum, or colon, all of which are the final portions of the digestive tract. In most cases, bright red blood indicates bleeding in the lower colon or rectum, while darker red blood is a sign of bleeding in the small bowel or upper colon. Very dark or black-red blood is often associated with bleeding in the stomach or other organs in the digestive system.

Essentially, the brighter red blood is fresher and is associated with the lower gastrointestinal tract. The dark red or black blood is old blood that has already travelled through the GI system for some time. It is associated with the upper GI tract, originating from as far back as the stomach, potentially (Nall, 2019).

What will a doctor do about the blood in my stool?

Rectal bleeding is commonly evaluated and treated by gastroenterologists. The first priority upon receiving a patient with rectal bleeding is always to correct any low blood volume or anemia, with fluids or a blood transfusion. They will then determine the site and cause of the bleeding, stop the bleeding, and prevent bleeding in the future if possible.

The doctor may order repeated blood tests to monitor changes, and will often initiate a colonoscopy or an endoscopy, depending on where they suspect the bleeding is happening (black stool indicates bleeding in the stomach, thus an endoscopy would be more useful than a colonoscopy).

What could be causing the blood in my stool?

There is a plethora of explanations for the presence of blood in your stool, ranging in severity. It is impossible to diagnose at home – see a doctor as soon as you see blood!

Hemorrhoids

One of the most common causes of rectal bleeding is hemorrhoids, which are inflamed anal blood vessels appearing either inside or outside the anus. These small bumps can occasionally bleed during bowel movements or wiping. Also referred to as piles, they can happen to anyone, but there are a few risk factors including pregnancy, chronic constipation or diarrhea, obesity, and a low fibre diet.

Hemorrhoids usually respond well to over-the-counter creams and suppositories that contain hydrocortisone. Taking warm baths frequently, eating a high-fibre diet, and using stool softeners can also help reduce the discomfort of hemorrhoids. If initial treatments fail, a doctor may perform minor surgery to remove the hemorrhoids (Kahn, 2021).

Diverticulitis

Diverticulosis is when small pockets called diverticula develop on the walls of the colon around a weakness in the organ’s muscular layers. These pockets or diverticula are extremely common. Sometimes diverticula can start bleeding, but this bleeding usually stops on its own.

Usually, these pockets do not cause symptoms or require treatment unless they become infected, which 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. There’s no single known cause of diverticular disease. Instead, experts believe that multiple genetic and environmental factors likely contribute to its development. Diverticulitis is treated with antibiotics and, if severe, surgery.

Crohn’s Disease

Crohn’s disease is a type of inflammatory bowel disease (IBD). As many as 780,000 Americans have the condition. More research about Crohn’s disease is necessary. Researchers aren’t sure how it begins or what specifically causes it. Influencing factors are the immune system, a person’s genes, and their environment.

Crohn’s disease most commonly occurs in the small intestine and the colon. It can affect any part of your gastrointestinal (GI) tract, from the mouth to the anus. It can involve some parts of the GI tract and skip other parts.

The range of severity for Crohn’s is mild to debilitating. Symptoms vary and can change over time, and include diarrhea, abdominal pain, blood in the stool, fatigue, and weight loss. In severe cases, the disease can lead to life threatening flares and complications. A cure for Crohn’s disease isn’t available yet, but the disease can be managed. A variety of treatment options exist that can lessen the severity and frequency of your symptoms, from medication to surgery (Holland, 2021).

Ulcerative Colitis

Ulcerative colitis occurs when the tissues lining the colon become inflamed – ulcerative colitis can also cause ulcers, or open sores that are prone to bleeding. Common symptoms are abdominal pain, bloody stool, diarrhea, rectal pain, and weight loss.

Treatments for UC vary, depending on the causes and range from antibiotics to surgery. Surgery involves removing your entire colon with the creation of a new pathway for waste. This pathway can be out through a small opening in your abdominal wall or redirected back through the end of your rectum (Higuera, 2020).

Polyps

Colonic polyps, also known as colorectal polyps, are growths that appear on the surface of the colon. In most cases, polyps don’t cause symptoms and are usually found on routine colon cancer screening exams. However, if symptoms do appear, they may include blood in the stool or rectal bleeding, abdominal pain, diarrhea, constipation, nausea, or vomiting.

Blood on your toilet paper or blood-streaked stools may be an indication of rectal bleeding and should be evaluated by a doctor. The best way to treat colonic polyps is to remove them. Your doctor will likely remove your polyps during a colonoscopy (Chun, 2019).

Irritable Bowel Syndrome (IBS)

The symptoms of IBS typically include cramping, abdominal pain, bloating and gas, constipation, diarrhea, and sometimes blood in the stool.

There is no cure for IBS. Treatment is aimed at symptom relief. Initially, your doctor may have you make certain lifestyle changes. These home remedies (such as diet and consistent exercise) are typically suggested before the use of medication. Although there are many ways to treat IBS, the exact cause is unknown. Possible causes include an overly sensitive colon or immune system. Postinfectious IBS is caused by a previous bacterial infection in the gastrointestinal tract. The varied possible causes make IBS difficult to prevent (Chan, n.d.).

Fissures

Fissures occur when tissues lining the anus, colon, or rectum are torn, resulting in pain and rectal bleeding. Common causes of anal fissure include passing large or hard stools, constipation and straining during bowel movements, and chronic diarrhea.

Warm baths, a high-fibre diet, and stool softeners can all help reduce symptoms of fissures. In severe cases, fissures may require prescription creams or surgery (Brazier, 2020).

Fistulas

A fistula occurs when an abnormal opening or pocket develops between two neighboring organs. Fistulas that appear between the anus and rectum, or anus and skin, can cause a discharge of white fluid and blood.

Just inside your anus are several glands that make fluid. Sometimes, they get blocked or clogged. When that happens, a bacteria buildup can create a swollen pocket of infected tissue and liquid, called an abscess. If you don’t treat the abscess, it’ll grow. Eventually, it’ll make its way to the outside and punch a hole in the skin somewhere near your anus so the gunk inside it can drain. The fistula is the tunnel that connects the gland to that opening. Common symptoms are pain, redness, and swelling around your anus.

Fistulas are sometimes treated with antibiotics, but they may require surgery if they progress (Khatri, 2020).

Prolapse

Weakened rectal tissues can allow a portion of the rectum to push forward or bulge outside of the anus, usually resulting in pain and, almost always, bleeding. Other than the obvious symptom of a visible rectum protruding from the anal canal, bleeding, mucous discharge, and incontinence are additional symptoms.

Prolapse is more common in older adults than in younger people. The condition often follows a long history of constipation and straining while attempting a bowel movement – pregnancy and obesity can also increase the likelihood of a prolapse occurring. Most people with this condition will require surgery to correct it (Goldstein, 2011).

Gastroenteritis

Gastroenteritis is inflammation of the stomach and intestines. IA virus, bacterium, or parasite can cause gastroenteritis. When it’s caused by a type of bacteria, it’s called bacterial gastroenteritis. The more common types of bacteria that can cause gastroenteritis include E. coli, salmonella, campylobacter, and shigella.

Symptoms can range from mild pain to life-threatening, and each person may experience symptoms differently. Symptoms may include nausea, vomiting, fever (which can get alarmingly high), bloody diarrhea, dehydration, and abdominal cramping.

Once a healthcare provider diagnoses your bacterial gastroenteritis, antibiotics can often cure the illness within a few days. You may need other treatment to replace the fluids and electrolytes in your body – it depends upon the severity of your illness. In some cases, you may need intravenous fluid replacement at a hospital (Lehrer, n.d.).

Colon Cancer

Cancer affecting the colon or rectum can cause irritation, inflammation, and bleeding. Nearly 48 percent of people with colorectal cancer will experience rectal bleeding.

Colon cancer is a very common form of cancer and it tends to progress slowly, so it is often treatable if caught early. Rectal cancer, while far rarer than colon cancer, is also usually curable if detected 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 (Pederson, 2013).

Symptom of an STI

Unprotected sexual intercourse 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 either an antibiotic, antiviral, or antifungal medication, depending if the cause is bacterial, viral, or fungal (Assi, 2014).

Always see a doctor

Because of the sheer number of different possibilities when it comes to blood in your stool, you must always contact your physician for a proper diagnosis and subsequent treatment. The presence of blood should never be taken lightly – better to be safe than sorry!


References

Assi, R. 2014. Sexually transmitted infections of the anus and rectumhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223259/

Brazier, Y. 2020. What is anal fissure and what causes it? https://www.medicalnewstoday.com/articles/what-is-anal-fissure-and-what-causes-it

Chan, W. n.d. Changes You Should Not Ignore if You Have IBShttps://aboutibs.org/signs-and-symptoms/changes-you-should-not-ignore-if-you-have-ibs-2/

Chun, C. 2019. Colonic (Colorectal) Polypshttps://www.healthline.com/health/colorectal-polyps

Goldstein, S. 2011. Rectal Prolapse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140332/

Higuera, V. 2020. What is Ulcerative Colitis? https://www.healthline.com/health/ulcerative-colitis

Holland, K. 2021. Understanding Crohn’s Disease. https://www.healthline.com/health/crohns-disease

Huizen, J. 2020. Why do I wipe blood after I poop? https://www.medicalnewstoday.com/articles/321023

Kahn, A. 2021. Hemorrhoids. https://www.healthline.com/health/hemorrhoids

Khatri, M. 2020. What is An Anal Fistula? https://www.webmd.com/digestive-disorders/anal-fistula-overview

Lehrer, J. n.d. Bacterial Gastroenteritis https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bacterial-gastroenteritis.html

Marks, J. 2019. Blood in the Stool (Rectal Bleeding, Hematochezia)https://www.medicinenet.com/blood_in_the_stool_rectal_bleeding/article.htm

Nall, R. 2019. Everything You Need to Know About Rectal Hemorrhage. https://www.healthline.com/health/rectal-bleeding

Pederson, A. 2013. Patient Delay in Colorectal Cancer Patients: Associations with Rectal Bleeding and Thoughts about Cancer. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069700

Sethi, S. 2019. Everything You Need to Know About Diverticulitis. https://www.healthline.com/health/diverticulitis

Lehrer, J. n.d. Bacterial Gastroenteritis https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/bacterial-gastroenteritis.html

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