When Should You Worry About Rectal Bleeding?

Most of the time, rectal bleeding is not caused by a serious medical condition, but the only way to be sure is to see a doctor for evaluation.

Rectal bleeding often originates in the lower intestine (colon) or rectum and may be noted when you see blood in the toilet or on toilet paper after wiping following a bowel movement.

Most of the time, rectal bleeding is not caused by a serious medical condition but the only way to be sure is to see a doctor for evaluation.

Symptoms of rectal bleeding include: 

• Visible blood in the toilet after a bowel movement
• Visible blood on toilet paper after wiping following a bowel movement
• Red- or maroon-colored stool

Depending on the cause, symptoms that may accompany rectal bleeding include:

• Rectal pain
• Rectal itching
• Tissue bulging around the anus
• Sensation of tearing, ripping, or burning pain during or after a bowel movement
• Confusion
• Fainting
• Dizziness
• Dehydration
• Leakage of stool or difficulty cleaning after a bowel movement

See a doctor for any rectal bleeding if you also experience: 

• Changes in frequency or consistency bowel movements
• Abdominal pain or cramping
• Weakness 
• Tiredness
• Fever

Common causes of rectal bleeding that are not serious include: 

• Hemorrhoids: swollen blood vessels in the rectum or anus that can cause pain, itching, and sometimes bleeding
• Anal fissure: a tear in the lining of the anus that may cause a sensation of tearing, ripping, or burning pain during or after a bowel movement 

Serious causes of rectal bleeding are less common and include: 

• Precancerous polyps near the end of the large intestine (colon) 
• Colorectal cancer 
• People may ignore rectal bleeding for years, assuming it is due to hemorrhoids, only to later be diagnosed with colorectal cancer
• It is important to see a doctor for evaluation of rectal bleeding because if colorectal cancer is diagnosed early, it can often be treated

Other causes

• Colitis (inflammation of the colon)
• Proctitis (inflammation of the rectum)
• Diverticular disease
• Angioectasias (abnormal blood vessels in the gastrointestinal tract)
• Rectal ulcers

The cause of rectal bleeding is diagnosed with a patient history and physical exam. The history may include questions about the rectal bleeding (including frequency, amount, and appearance), bowel habits, family history of colorectal cancer or other cancers, and whether other symptoms such as pain accompany the bleeding. The physical exam usually involves a rectal examination. 

Other tests to help diagnose the cause of rectal bleeding include 

• Anoscopy to inspect the anal canal and lower rectum: this is usually an office procedure that does not require sedation
• Sigmoidoscopy to examine the rectum and most of the lower large intestine
• Colonoscopy to examine the entire colon
• Esophagogastroduodenoscopy
• Wireless capsule endoscopy 
• Push enteroscopy
• Double-balloon enteroscopy
• Radionuclide scans
• Angiography
• Blood tests
  • Complete blood cell (CBC) count
  • Serum electrolyte levels
  • Coagulation profile, including activated partial thromboplastin time (aptt), prothrombin time (PT), manual platelet count, and bleeding time

Treatment for rectal bleeding depends on the cause. 

• Hemorrhoids
  • Fiber supplements
  • Laxatives 
  • Warm sitz baths 
  • Topical treatments: pain-relieving creams and hydrocortisone rectal suppositories to help temporarily relieve pain, inflammation, and itching
  • Surgery for severe cases
    • Rubber band ligation 
    • Laser, infrared, or bipolar coagulation
    • Sclerotherapy 
• Anal fissure 
  • Fiber therapy
  • Laxatives 
  • Topical nifedipine and topical nitroglycerin 
  • Botulinum toxin 
  • Surgery for cases that persist despite other treatments
    • Lateral internal sphincterotomy
• Precancerous polyps 
  • Surgical removal of polyps (polypectomy)
• Colorectal cancer 
  • Surgery to remove the part of the colon or rectum that has cancer
  • Chemotherapy
  • Radiation therapy
• Colitis 
  • Diet 
  • Avoiding medications that worsen symptoms including nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)
  • Topical medications applied directly to the rectum
    • 5-ASA (aminosalicylic acid or mesalamine)
  • Topical or oral steroid medication 
  • Oral 5-ASA 
  • Oral steroids
  • Biologics: adalimumab (Humira), infliximab (Remicade, Inflectra, Renflexis), and vedolizumab (Entyvio)
  • Intravenous steroids for severe cases
  • Other medications: tofacitinib or cyclosporine