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.
- Rectal Bleeding (Blood After Wiping)
- Causes of Rectal Bleeding
- Hemorrhoids and Rectal Bleeding
- Treatment of Rectal Bleeding
- Symptoms of Anal Fissures
- Treatment of Anal Fissures
- Inflammatory Bowel Disease (IBD)
- Treatment of Bowel Disease
- Rectal Pain
- What are the symptoms associated with rectal bleeding?
- Prevention Tips for a healthy colon
- When should you 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.
Rectal Bleeding (Blood After Wiping)
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.
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.
Rectal bleeding often reveals itself as bright red blood on the toilet paper—usually after a bowel movement—or by turning the toilet bowl water red. Rectal bleeding can also present as extremely dark stool, ranging in color from deep red/maroon to black, and sometimes appearing tar-like (melena).
The color of the blood can indicate where the bleeding is coming from:
- Bright red blood usually indicates bleeding low in the colon or rectum
- Dark red or maroon blood usually indicates bleeding higher in the colon or the small bowel
- Melena usually means bleeding in the stomach, such as bleeding from ulcers
Not all rectal bleeding is visible to the eye. In some cases, rectal bleeding can only be seen by looking at a stool sample through a microscope. There is also a test, called a Hemoccult® test that can be done in a doctor’s office.
Causes of Rectal Bleeding
Although rectal bleeding is common, only about one-third of those affected seek treatment. Symptoms usually develop quickly, and most causes are treatable and not serious. In some cases, rectal bleeding can be a symptom of a serious disease, such as colorectal cancer. Therefore, all rectal bleeding should be reported to the primary care physician. He or she can do a rectal examination or order tests like a colonoscopy to determine the cause of the bleeding.
Rectal bleeding can be caused by:
- anal fissure
- anal abscess or fistula
- inflammatory bowel disease (IBD)
- large polyps
- colon cancer
Hemorrhoids and Rectal Bleeding
Hemorrhoids are swollen veins in the rectum (internal hemorrhoids) or the anus (external hemorrhoids). Hemorrhoids, also called piles, can commonly develop because of chronic constipation or straining at stools,pregnancy, work strain (heavy lifting, etc.), obesity, or anal intercourse.
Hemorrhoid treatment includes addressing the underlying causes, such as treating the constipation or straining habits, or changing work habits if necessary. Sometimes surgical treatment is necessary and may include one of the following methods:
- Rubber band ligation: a rubber band placed around the base of the hemorrhoid cuts off circulation to the bulk of the hemorrhoid and causes the hemorrhoid to wither away.
- Sclerotherapy: the injection of a chemical solution around the blood vessel shrinks the hemorrhoid.
- Laser: a precise laser beam is used to burn away small hemorrhoids.
- Hemorrhoidal arterial ligation: uses a Doppler probe to locate and tie the blood vessels feeding the hemorrhoid, to shrink it.
- Procedure for prolapsed hemorrhoids (PPH): puts hemorrhoids that have come out of the anal canal back in their original positions.
- Hemorrhoidectomy: surgical removal of the hemorrhoid.
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.
Treatment of Rectal Bleeding
Lifestyle changes can help prevent and ease hemorrhoids. These include:
- 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.
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
- lump or skin tag
Treatment of Anal Fissures
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.
Inflammatory Bowel Disease (IBD)
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:
- stomach cramping or pain
- urge to have a bowel movement when not needed
- weight loss
Treatment of Bowel Disease
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.
Rectal pain is pain or discomfort in the lower portion of the gastrointestinal tract. The term is often used interchangeably with pain in the anus or anal pain. It is a fairly common problem and can result from conditions such as hemorrhoids or anal fissures. Rectal pain can be associated with symptoms such as prolapse, pressure, or bleeding. Rectal or anal pain can also occur with inflammatory diseases of the bowel, localized infections, or minor injuries to the area. Some causes of rectal pain, such as hemorrhoids or anal fissures, can be accompanied by other symptoms like blood in the stool or bleeding. Diarrhea orconstipation may also be present. Cancers are a rare cause of rectal pain. Levator syndrome, also known as levator ani syndrome, is a spasm of the levator ani muscle that causes fleeting pain in the rectum. Proctalgia fugax is another term that refers to rectal pain occurring from muscle spasm.
What are the symptoms associated with rectal bleeding?
The symptoms of rectal bleeding may include:
- Rectal pain and/or pressure
- Bright red blood in/on the stool, on underwear, and/or in the toilet
- Red, maroon, or black stool color
- Stool that has a tar-like appearance
- Feeling lightheaded or dizzy
Prevention Tips for a healthy colon
Lifestyle changes can decrease the incidence of blood when wiping.
- 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.
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.
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.