Rectal bleeding (blood in stools)
What is rectal bleeding?
Rectal bleeding, or blood in stools, is the term used to describe any loss of blood that passes through the anus, which can originate from anywhere in the digestive system.
Rectal bleeding is very common and can have numerous causes. It is often due to less serious causes; however, occasionally it can be due to a life-threatening condition. All cases of rectal bleeding should be assessed by a doctor.
Rectal bleeding can vary in its color, duration and frequency. Bright red blood usually indicates bleeding from somewhere close to the anus, such as from the rectum or anus. Darker, sticky blood generally means bleeding is higher up in the digestive system, such as in the stomach or small intestine. Other associated symptoms can include rectal or abdominal pain, itching and irritation around the anus, or a mass around the anus.
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Anus
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
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Rectum
The final part of the large intestine, leading to the anus.
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Abdominal
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
Causes
Potential causes of rectal bleeding include:
Hemorrhoids
Hemorrhoids, commonly known as piles, are swollen, potentially painful varicose veins bulging from the rectal wall. They can look like small grapes and sometimes protrude outside your anus. They are usually caused by straining to pass hardened stools (constipation), obesity, heavy lifting or pregnancy. Although they are not life-threatening, they can cause great discomfort, itching and irritation. Bleeding is usually bright red and characteristically seen on the toilet paper. They are a common cause of rectal bleeding.
Anal fissure
An anal fissure is either a small tear or open sore in the lining of your anal passage. It can be quite painful, especially when passing a bowel movement. The bleeding is usually bright red, but does not typically last long. It is commonly caused by constipation. Treatment comprises pain relief and medication to reduce constipation. They usually heal themselves over a few weeks, but some need further medical care, especially if severely painful or not healing after six weeks.
Diverticular disease
Diverticular disease is a very common disorder of the bowel in which small, abnormal pouches (diverticula) form in the wall of the large bowel. Having diverticular disease without any symptoms is known as diverticulosis. However, if these pouches become inflamed or infected, it is called diverticulitis. The pouches sometimes have weak blood vessels in them that can burst, causing painless but heavy bleeding. The blood is usually bright red and warrants prompt medical attention as there can be significant blood loss. Diverticulitis can rarely cause bleeding.
Angiodysplasia
Angiodysplasia is a condition in which blood vessels abnormally develop in the bowel. These blood vessels are prone to bleeding, which is often painless, heavy and sudden. The blood is usually bright red. It is one of the leading causes of rectal bleeding in people over the age of 60.
Polyps
Polyps are non-cancerous growths, although a few may develop into bowel cancers, which grow from the lining of the bowel wall. Large polyps can occasionally bleed, but are variable in the type and frequency of bleeding.
Bowel cancer
Bowel cancer is one of the leading causes of cancer in the US. Symptoms depend on which area of the large bowel the cancer develops in. Rectal bleeding may be a symptom of bowel cancer, particularly it the cancer is closer to the anus. The bleeding can vary from bright red to dark blood. For this reason, rectal bleeding needs to be assessed by a doctor, especially if you are over 50 years old or have a family history of bowel cancer.
Other causes
Other causes of rectal bleeding include:
- Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, can cause bloody diarrhea. Often mucus is also present in the stools;
- Gastroenteritis is usually a short-term condition causing inflammation of the lining of the digestive system. It can cause fevers, vomiting, cramps and diarrhea that can contain blood or mucus, and;
- Gastritis and stomach ulcers can occasionally cause rectal bleeding. The bleeding typically results in dark and sticky stools (melena), but rarely it can be bright red blood if bleeding is heavy.
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Anus
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
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Diarrhea
Passing watery stools in large volumes. Liquid feces and/or frequent stools.
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Mucus
A thick, viscous liquid that is secreted for lubrication and to form a protective lining over certain tissues.
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Polyps
A small growth that protrudes from a mucous membrane.
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Ulcers
An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.
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Varicose veins
A twisted and enlarged vein that is near the surface of the skin or other organ.
Risk factors
Risk factors for rectal bleeding include:
- Age - as you get older, blood vessels within the digestive system can weaken and become prone to bleeding;
- Constipation - many cases of rectal bleeding can be linked to damage and pressure caused by constipation;
- Blood-thinning medications, such as aspirin or warfarin can worsen rectal bleeding, and;
- Family history - if you have a family history of conditions such as hemorrhoids, inflammatory bowel disease, polyps or bowel cancer.
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Polyps
A small growth that protrudes from a mucous membrane.
Methods for diagnosis
Rectal bleeding warrants medical assessment to rule out any serious cause. Do not be embarrassed about discussing this with your doctor as it is a very common condition. The method of diagnosis will depend on your age and symptoms and may include all or a few of the following tests:
Digital rectal examination
This involves your doctor inserting a gloved, lubricated finger into your anus to check your rectum for lumps or abnormalities. This is a very common, quick and often painless procedure.
Proctoscopy
This common procedure involves insertion of a thin, hollow lubricated instrument (proctoscope) into your rectum. The instrument has a tiny light and allows your rectum to be examined closely. If your doctor suspects that you are bleeding further up your colon, other tests, such as colonoscopy, may be suggested.
Colonoscopy
A colonoscopy involves inserting a thin, flexible, lit tube (endoscope) into the rectum to examine your colon and lower bowels. You will be given a mild sedative to help you relax during the procedure and often will be asked not to eat for 12 hours prior to the test. The endoscope can take video, photos and tissues samples, providing your doctor with a highly detailed view of your intestines.
Gastroscopy
Gastroscopy is similar to colonoscopy, but the tube enters via the mouth and is used to examine the upper digestive tract, including the esophagus, stomach and first part of the small intestine. Your doctor may organize this test if you have had melena, to help in the diagnosis of conditions such as bleeding stomach ulcers.
Computer tomography (CT) or nuclear scans
Special scans of the abdomen, including CT or nuclear scans, may be performed to help visualize abdominal structures and/or the source of bleeding. These tests are generally used to assess for more serious causes of rectal bleeding.
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Anus
The opening at the end of the anal canal, between the buttocks, through which fecal matter and intestinal gas exits the body.
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Colon
The part of the large intestine that leads to the rectum.
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Colonoscopy
A medical procedure that uses a colonoscope to examine the large bowel.
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Digestive tract
The series of organs within the body that contribute to the digestion of food. It begins at the mouth and ends at the anus, and includes the stomach, small and large intestines as well as the pancreas, gallbladder and liver.
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Esophagus
Also called the gullet or food pipe, it is the muscular tube connecting the throat and stomach. It is lined with a mucous membrane. After ingestion, food and drink travel down the esophagus to be digested in the stomach.
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Rectum
The final part of the large intestine, leading to the anus.
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Ulcers
An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.
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Abdominal
Relating to the abdomen, the middle portion of the trunk which contains organs such as the intestines, stomach and liver.
Types of treatment
The type of treatment you are offered will depend on the cause of your rectal bleeding.
Hemorrhoids and anal fissure
Many cases of hemorrhoids and anal fissure can be resolved with simple lifestyle changes and home treatments. In certain cases, hemorrhoids may need surgery, which can involve stapling, banding procedures, injection or infrared treatment. Anal fissures that fail to heal can also be treated using surgery. Changing your diet to reduce constipation may be the first step you are advised to take towards resolving these conditions.
Angiodysplasia
Bleeding related to angiodysplasia (a condition in which blood vessels abnormally form in the bowel) is initially managed in a hospital, so a person can be closely monitored and supported with intravenous fluids and blood transfusions until the bleeding resolves. In severe cases, or where bleeding does not cease, a variety of surgical procedures can be used.
Diverticular disease
In rare cases, hemorrhaging (uncontrolled bleeding) may occur and require immediate surgery to prevent further blood loss. Bowel resection (surgical removal of the bleeding part of the bowel) may need to be done as an emergency procedure. Less severe or slower bleeds may be able to be managed via colonoscopy rather than surgery.
Polyps
Polyps that are found at the time of colonoscopy can generally be removed at the same time using small biopsy or snaring devices. Often the removed polyps are sent to be examined by a pathologist to ensure no cancerous growths are detected.
Bowel cancer
If you have been diagnosed with bowel cancer, you may need to undergo surgery, chemotherapy, radiotherapy, biological therapy or a combination of all of these. Please refer to our report on bowel cancer for full details.
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Chemotherapy
A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.
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Colonoscopy
A medical procedure that uses a colonoscope to examine the large bowel.
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Polyps
A small growth that protrudes from a mucous membrane.
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Radiotherapy
A treatment that uses ionizing radiation to kill or control growth of malignant cancer cells.
Potential complications
Complications associated with rectal bleeding are as follows:
Anemia
Loss of blood will eventually lead to anemia, which can cause pale skin, breathlessness, weakness, dizziness and fatigue.
Shock
If you lose a large volume of blood, your body may go into shock if untreated. This can be potentially fatal, but can be managed with the prompt medical care.
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Anemia
A deficiency in red blood cells or hemoglobin in the body.
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Shock
A life-threatening condition in which the organs and other tissues do not receive adequate blood flow.
Prognosis
The outcome for rectal bleeding depends on your diagnosis and individual circumstances. Rectal bleeding generally needs medical assessment to rule out serious conditions.
Prevention
Steps to help prevent rectal bleeding depend on the cause, but include the following:
- Eat a healthy diet high in fiber, fruits, vegetables, cereals and wholegrain products;
- Drink more water. Drinking water throughout the day will help keep your stools soft and keep your digestive system moving, and;
- Get active. Try to avoid sitting for long periods of time and exercise as often as you can.
Get regularly screened for bowel cancer if you are over 50 years of age or have a family history of bowel cancer. Discuss screening options with your doctor.
References
- Anal fistula - NHS Choices. Accessed 9 July 2014 from link here
- Blood in the stool (rectal bleeding) in adults. Accessed 8 July 2014 from link here
- Bowel cancer - NHS Choices. Accessed 9 July 2014 from link here
- Edwards A. & Stott N. (1996). The incidence and causes of rectal bleeding. The British Journal of General Practice 46: 625.
- Mark Shapley Gemma Mansell Joanne L Jordan et al. Systematic Review. BJGP.
- Rectal bleeding - NHS Choices. Accessed 8 July 2014 from link here
- Rectal Bleeding in Adults Blood in Stool. Information | Patient.co.uk. (-a). Accessed 9 July 2014 from link here
- Shapley M. Mansell G. Jordan J.L. et al. (2010). Positive predictive values of ?5% in primary care for cancer: systematic review. British Journal of General Practice 60: e366e377.
- Solitary rectal ulcer syndrome... [JNMA J Nepal Med Assoc. 2008 Oct-Dec] - PubMed - NCBI. Accessed 8 July 2014 from link here
- Stomach ulcer | Better Health Channel. Accessed 9 July 2014 from link here
10 Most frequently asked questions (FAQs)
Rectal bleeding occurs when you see blood in the toilet pan or on the toilet paper after wiping your anus. Bright red blood usually means you are bleeding from somewhere close to your anus, such as from your rectum or anus itself. Darker, stickier blood means you are bleeding from higher up in your digestive tract such as in the stomach or small intestine - this needs medical investigation straight away. What are the symptoms of rectal bleeding? Signs and symptoms of rectal bleeding can include: fresh (bright red) blood appearing in the toilet pan, on toilet paper or underwear; darker, stickier blood that may be plum-colored or tarry in appearance; profuse bleeding with or without pain, and; itching and irritation around your anus. If you have rectal bleeding alongside any of the following, your doctor may arrange urgent further investigation or referral to a specialist: black sticky stools (melena); you are over 40 years of age and your bowels have been looser for at least six weeks; you are over 60 years of age and have bleeding for at least six weeks; you have anemia (which can be from long-term bleeding); you have a family history of colon cancer; your doctor found a lump or abnormality after examining you; you have ulcerative colitis or Crohn's disease; you feel dizzy, have breathing problems or suddenly feel weak; you vomit up what looks like black coffee grinds or blood, and; you have severe abdominal pain. What causes rectal bleeding? It is worth noting that while taking medications such as iron supplements or eating lots of beetroot can change the color of your stool, it is recommended you visit your doctor if you notice red, plum or black-colored stools. Other causes of rectal bleeding can include: 1) Hemorrhoids (piles), potentially painful varicose veins that bulge from the rectal wall. They can look like small grapes and sometimes protrude outside of your anus. Bleeding is usually bright red and characteristically seen on the toilet paper. There can be quite a sudden, small bright red bleed if a hemorrhoid bursts, with lighter bleeding afterwards. 2) Anal fissure - this is a small tear or open sore in the lining of your anal passage. The bleeding is usually bright red, but doesn't typically last long. 3) Diverticula - these are small pouches or bulges that form in your colon if you have a condition called diverticulosis. The pouches sometimes have weak blood vessels in them that can burst, causing painless but often heavy bleeding. The blood is usually bright red and warrants prompt medical attention as there can be significant blood loss. 4) Inflammatory bowel disease (such as Crohn's disease or ulcerative colitis) can cause bloody diarrhea. 5) Bleeding disorders such as hemophilia can cause profuse bleeding in some of the above situations. 6) A bleeding gastric (stomach) or small intestinal ulcer - these can be life-threatening very quickly due to the amount of blood lost. The blood seen rectally is typically dark and sticky. 7) Non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac can cause ulceration and bleeding in the upper digestive tract. 8) Endometriosis. Who gets rectal bleeding? Risk factors for rectal bleeding include: older age, constipation, anticoagulant drugs such as aspirin or warfarin, and a family history of conditions such as hemorrhoids, inflammatory bowel disease, polyps or bowel cancer. How is rectal bleeding diagnosed? The method of diagnosis will depend on your age and symptoms and may include all or a few of the following tests: digital rectal examination (DRE) your doctor will insert a gloved, lubricated finger into your anus to check your rectum for lumps or abnormalities. This is a very common, quick and often painless procedure. Proctoscopy - a common procedure which involves insertion of a thin, hollow lubricated instrument (proctoscope) into your rectum. The instrument is lit and allows your rectum to be examined closely. Colonoscopy - involves inserting a thin, flexible, lit tube (endoscope) into the rectum to examine your colon and lower bowels. You will be given a mild sedative to help you relax during the procedure and often will be asked not to eat for 12 hours before the test. The endoscope can take video, photos and tissues samples, providing your doctor with a highly detailed view of your intestines. Computer tomography (CT) or nuclear scans may be performed to visualize abdominal structures and/or the source of bleeding more clearly. Can rectal bleeding be cured? Some cases or rectal bleeding are easier to treat than others. Many cases of hemorrhoids can be resolved with simple lifestyle changes and home treatments. Surgery is typically performed on polyps that are found at the time of colonoscopy. These can generally be removed in the same procedure using small biopsy or snaring devices. In rare cases, hemorrhaging (uncontrolled bleeding) may occur. It requires immediate surgery to prevent further blood loss. Bowel resection (surgical removal of the bleeding part of the bowel) may need to be done as an emergency procedure. Less severe or slower bleeds from diverticula may be able to be managed via colonoscopy rather than surgery. If you have been diagnosed with colon cancer, you may need to undergo surgery, chemotherapy, radiation therapy, biological therapy or a combination of all. Please see our report on colon cancer for full details. Will rectal bleeding clear up on its own? The outcome for rectal bleeding depends on your diagnosis and individual circumstances. If you have hemorrhoids you may have ongoing but non life-threatening bleeding. Your doctor will be able to advise you on any self-help treatments such as dietary changes to avoid constipation. Rectal bleeding generally needs medical assessment to rule out serious conditions. Is rectal bleeding contagious? The only type of rectal bleeding that is contagious is when the cause is gastroenteritis. This is a highly contagious condition as a result of infections with bacteria, viruses or parasites. Are there different types of rectal bleeding? Bright red blood usually means you are bleeding from somewhere close to your anus, such as from your rectum or anus itself. Darker, stickier blood means you are bleeding from higher up in your digestive tract such as in the stomach or small intestine - this needs medical investigation straight away. Is rectal bleeding serious? Complications of rectal bleeding are: anemia caused by continued loss of blood. Symptoms to watch out for are pale skin, breathlessness, weakness, dizziness and fatigue. Shock - if you lose a large volume of blood, your body may go into shock if untreated. This can be potentially fatal but can be managed with the prompt medical care. Colon cancer is not a complication of rectal bleeding, but rectal bleeding may be due to bowel cancer, so if you have rectal bleeding, it is important to see your doctor to rule out colon cancer.
Related topics
An anal fissure is a small tear or open sore in the lining of the rectum. It can cause pain and bleeding when passing a bowel movement, particularly if the stool is large or dry. Colorectal cancer is the name for cancers that arise in the large intestine or rectum. Also known as colon cancer or colorectal cancer, bowel cancer can interfere with bowel function and spread to other parts of the body, such as the liver and lungs. Crohn's disease is an inflammatory bowel condition that mainly affects the intestines. The main symptoms include diarrhoea, abdominal cramping and tiredness. Although there is no known cure, Crohn’s disease can be managed with medications, dietary measures and, in some cases, surgery. Diverticulitis is where abnormal pouches form in the wall of the large intestines and become infected. It presents as abdominal pain, fever and unwellness. Treatment is important to prevent further complications.