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If you finish going to the bathroom and notice a small amount of bright-red to black blood in the toilet bowl, on the toilet paper, or in your stool, you’re likely experiencing rectal bleeding.

Hemorrhoids are the most common cause of rectal bleeding, but there are many possible reasons it might occur.

Read on to find out more about why you might experience rectal bleeding and what to do if it happens.

Causes of rectal bleeding can range from mild to serious. Conditions associated with rectal bleeding include:

  • Anal fissures. Small tears in the lining of the anus can lead to bleeding and pain when passing stools. Tears can occur because of constipation or during childbirth.
  • Angiodysplasia. Enlarged blood vessels develop in the intestine. They can become fragile, break, and bleed.
  • Hemorrhoids. Also called piles, these are masses of tissue made up of blood vessels and muscle fibers. Internal hemorrhoids are inside the body. They don’t hurt but can cause bleeding. In some cases, they can pass through the anus.
  • Constipation. Hard stool and straining to relieve constipation can lead to anal fissures and hemorrhoids, both of which can result in bleeding.
  • Anal or colorectal polyps. Polyps are growths that can appear in many places throughout the body. If polyps develop in the intestine, they can bleed. Polyps aren’t cancerous, but some can become malignant in time.
  • Ulcers. An ulcer can form when an erosion worsens in the digestive track. Black, tarry stools may occur if an ulcer is bleeding higher in the gut, but an ulcer further down may produce bright red blood. However, this isn’t always the case, and your doctor will need to investigate.
  • Anal cancer or colon cancer. As tumors form, they need blood vessels to grow. The blood vessels in the colon are fragile and can tear, causing bleeding. Only 3.4 percent of cases of rectal bleeding are due to colon cancer.
  • Inflammatory bowel disease (IBD). This includes ulcerative colitis (UC) and Crohn’s disease. Bleeding may occur alongside rectal pain and diarrhea.
  • Diverticular disease. Diverticula are small pouches or bulges in the colon where, over time, blood vessels can erode, rupture, and bleed. When there are no symptoms, it’s called diverticulosis, but if inflammation occurs, this is diverticulitis. Together, they’re called diverticular disease.
  • Infections. Intestinal infection, or infections caused by bacteria, such as salmonella, can cause bleeding.
  • Bleeding conditions. Some conditions can contribute to bleeding because they affect the blood’s ability to coagulate. They include vitamin K deficiency, hemophilia, and a low platelet count, also called thrombocytopenia.
  • Damage to the upper gastrointestinal (GI) tract. Tears or other problems in the stomach or even the esophagus can cause bleeding from the rectum. Bleeding from the upper GI tract is more likely to appear as black, tarry stools.

Less common rectal bleeding causes include allergic reactions to certain food types.

The most apparent sign of rectal bleeding is red blood on toilet tissue or visible blood or red-tinged stool in the toilet bowl. However, it’s important you pay attention to the color of the blood (and the color of your stools) as it can indicate different things:

  • Bright red blood indicates bleeding somewhere in the lower gastrointestinal tract, such as the colon or rectum.
  • Dark red or wine-colored blood may indicate bleeding in the small intestine or early portion of the colon.
  • Black, tarry stools may indicate bleeding from the stomach or the upper part of the small intestine.

Additional symptoms associated with rectal bleeding include:

Severe rectal bleeding can constitute a medical emergency. Go to an emergency room if you’re also experiencing any of the following symptoms:

  • cold, clammy skin
  • confusion
  • continuous rectal bleeding
  • fainting and dizziness
  • painful abdominal cramping
  • rapid breathing
  • severe anal pain
  • severe nausea
  • blood in vomit

Make an appointment to see your doctor if you experience less severe rectal bleeding, such as small drops of blood from the rectum. Because a small amount of rectal bleeding can quickly turn into a large amount, seeking treatment in the early stages is important.

Most cases of rectal bleeding in middle-aged and older people are due to hemorrhoids. In around 95 percent of cases, rectal bleeding will stop without treatment, but this doesn’t mean the underlying cause has also disappeared.

Statistics suggest that only 40 percent of people with rectal bleeding seek medical help, but bleeding can also be a sign of a serious condition, such as cancer, so you shouldn’t ignore it if it happens.

If you experience rectal bleeding, it’s always a good idea to seek medical help, as it may be a sign of an underlying problem that needs treatment. If bleeding is heavy or occurs in many bowel movements, it’s best to ask your doctor about it as soon as possible.

Your doctor will start by asking you about your symptoms. Questions may include when you first noticed the bleeding, related symptoms you’re experiencing, and what color the blood is.

  • Visual or physical exam. The doctor will look or feel to check the affected area. This can include inserting a gloved, lubricated finger into the anus to check for abnormalities, such as hemorrhoids.
  • Endoscopic procedures. The doctor inserts a thin, flexible lighted scope with a camera into the anus. This allows the doctor to view the area. Examples include a sigmoidoscopy or a colonoscopy.
  • Blood tests. A complete blood count (CBC) can help assess the extent of the bleeding and show if anemia is present.
  • Stool tests. These can show if there’s bleeding that isn’t visible.
  • Gastric lavage. If the doctor suspects the problem may lie in the stomach, they may pass a tube through the nose into the stomach to remove the contents and try to locate the site of any bleeding.
  • Imaging tests. This could be a scan or an X-ray, possibly with a contrasting agent, such as barium.

Rectal bleeding treatments depend on the cause and severity.

Home remedies

At home, one way to relieve the pain and discomfort of hemorrhoids may be by taking warm baths. Applying over-the-counter or prescription creams can also reduce irritation.

If anal fissures result from constipation, treating the constipation may allow the fissures to heal.

At-home treatments to prevent constipation can reduce the risk of rectal bleeding. These include:

Medical treatment

If home constipation remedies don’t work, ask your doctor about medical and prescription options.

  • Hemorrhoids may need more invasive treatment if the pain is severe or the hemorrhoids are large. These include rubber band ligation, laser treatments, and surgical removal.
  • Anal fissures may resolve on their own, but a doctor may prescribe antibiotics if an infection develops.
  • Colon cancer will require long-term treatment, such as surgery, chemotherapy, and radiation, to remove the cancer and reduce the risk of recurrence.
  • Polyps may need treatment if they’re large, if there are many of them, or if cells changes suggest they could become cancerous. A doctor can remove polyps during a colonoscopy.

Shop online for over-the-counter hemorrhoid creams.

Rectal bleeding is a common problem and often results from a minor issue, such as hemorrhoids. However, it can also be a sign of a more serious disease, such as colorectal cancer.

Seeking medical advice early for any rectal bleeding will give a doctor the chance to rule out a more serious condition or offer treatment, if appropriate. If you’re taking blood thinners for another condition, ask your doctor about rectal bleeding as a side effect as the threshold for seeking help may be lower.