Why Is There Blood on the Toilet Paper?

Medically reviewed by Daniel Murrell, MD on April 4, 2017Written by Susan York Morris on April 4, 2017

Overview

Seeing blood on toilet paper can be a little alarming. You may have heard that rectal bleeding is a sign of cancer, but more often, bleeding is a symptom of a less serious cause. Many things can cause rectal bleeding, including a bad case of diarrhea or constipation. Keep reading to learn the most common causes of blood when you wipe, how to treat it, and when to see a doctor.

Seek emergency attention if you are bleeding a lot. You should also see a doctor if you are experiencing dizziness, weakness, and confusion alongside bleeding.

Bleeding due to hemorrhoids

Hemorrhoids, or swollen veins inside the anus, are the most common cause of anal bleeding. Approximately 1 in 20 people will get hemorrhoids at some point in their life. Hemorrhoids occur inside the rectum, which is the last part of the large intestine, and around the outer area of the anus.

Symptoms of hemorrhoids

The blood from hemorrhoids is usually bright red. Other symptoms can include anal itching and pain. Some people aren’t aware of hemorrhoids until they bleed. In some cases, pain is due to clots (thrombosed hemorrhoid). Your doctor may need to drain these.

Treatment

Lifestyle changes can help prevent and ease hemorrhoids. These include:

Hemorrhoid prevention

  • Drink plenty of water to avoid dehydration.
  • Add fiber to your diet and lose weight to prevent constipation.
  • Use wet wipes or wet toilet paper to clean the area completely and ease irritation.
  • Avoid waiting too long to go.
  • Don’t strain or force yourself to go as the pressure can make it worse.

Over-the-counter ointments and hydrocortisone suppositories can also alleviate discomfort. Persistent hemorrhoids may protrude from the anus, especially with frequent constipation or straining. Wash the area with warm water after a bowel movement to help them shrink faster. If your hemorrhoids are large, your doctor may need to shrink or remove them surgically.

Read more: Hemorrhoids: Causes, diagnosis, and treatment »

Small tears in the lining of the anus

Anal fissures, sometimes called anal ulcers, are small tears in the lining of the anus. They are caused by straining while having a bowel movement, diarrhea, large stools, anal sex, and childbirth. Anal fissures are very common in infants.

Symptoms of anal fissures

Alongside blood when wiping, you may also experience:

  • pain during, and sometimes after having a bowel movement
  • anal spasms
  • blood after a bowel movement
  • itching
  • lump or skin tag

Treatment

Anal fissures usually heal without treatment or can be treated at home.

How to treat anal fissures

  • Drink more fluids and eat more fiber, such as fruits and vegetables.
  • Try fiber supplements, if changing your diet hasn’t helped.
  • Take sitz baths to increase blood flow to the area and relax anal muscles.
  • Use topical pain relievers (lidocaine) to ease discomfort.
  • Try over-the-counter laxatives to encourage bowel movement.

See a doctor if your symptoms don’t get better with treatment after two weeks. Your doctor can help make a more accurate diagnosis to make sure you get the right treatment.

Read more: Anal fissures: Causes, treatment, and prevention »

Inflammatory bowel disease

Inflammatory bowel disease (IBD) is a term used to describe several diseases of the colon and bowel, including ulcerative colitis and Crohn’s disease. These are autoimmune diseases, meaning your body sends white blood cells to parts of the digestive tract, where they release chemicals that cause damage, or inflammation, to the bowels.

Symptoms of IBD

Rectal bleeding is a symptom of IBD, but you can also experience other symptoms, depending on the cause. These include:

  • diarrhea
  • stomach cramping or pain
  • bloating
  • urge to have a bowel movement when not needed
  • weight loss
  • anemia

Treatment

There is no cure for most types of IBD, and treatment depends on the specific diagnosis. These involve:

  • anti-inflammatory drugs to ease the digestive tract
  • immune suppressants to block the immune system from attacking your body
  • antibiotics to kill any bacteria that may trigger IBD

When medications fail to control severe cases of IBD, your doctor may recommend surgery to remove affected portions of your colon.

In general, IBD requires careful monitoring and medical care. Maintaining a healthy diet, exercising regularly, and avoiding smoking can help prevent IBD or a relapse.

Read more: Difference between Crohn’s, ulcerative colitis, and IBD »

Colorectal cancer

Colorectal cancer is cancer of the colon or rectum. Most of these cancers are associated with small, non-cancerous tumors, called polyps, which grow on the lining of the large intestine or rectum.

Symptoms of colorectal cancer

In addition to bleeding from the anus, you may also experience:

  • a change in bowel habits lasting longer than four weeks
  • stools that are very narrow, like a pencil
  • abdominal pain or discomfort
  • unexplained weight loss
  • fatigue

Treatment

Talk to your doctor if you believe you have colorectal cancer. Your doctor can help determine what stage the cancer is in and recommend treatment. The earlier you get treatment, the better your outcome. Often, the first step is surgery to remove cancerous polyps or sections of the colon. You may need chemotherapy or radiation treatment to get rid of remaining cancerous cells.

Read more: Colorectal cancer: Causes, treatment, prevention, and more »

When should you see a doctor?

See your doctor if you have:

  • pain that worsens or persists
  • the blood is dark or thick-looking
  • symptoms that don’t get better within two weeks
  • black and sticky stool (which can indicate digested blood)

Seek immediate medical care if you feel weak, dizzy, or confused. You should also seek emergency medical attention if you’re bleeding a lot.

Testing

Your doctor will decide what tests you need based on your symptoms and medical history. These tests may include a rectal exam or fecal occult blood test to look for abnormalities or blood in your colon. Your doctor may also order colonoscopy, flexible sigmoidoscopy, or endoscopy to look at the inside of your digestive tract. These imaging tests can look for blockage or abnormal growths.

Tips for a healthy colon

Lifestyle changes can decrease the incidence of blood when wiping.

Prevention tips

  • Increase the amount of fiber in your diet by adding vegetables, fruits, berries, whole-grain breads and cereals, nuts, and beans.
  • Supplement your diet with soluble fiber supplements.
  • Manage your weight with exercise and diet to encourage regular bowel movements.
  • Drink ample fluids to ward off constipation.
  • Take warm baths, especially if you have rectal bleeding after bowel movements.

Outlook

In most cases, bleeding from the rectum goes away without treatment. Only one to two percent of rectal bleeding incidents are due to colon cancer. Because of the risk of more serious diseases, report frequent anal bleeding to your doctor.

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