Hemorrhoid Symptoms: Should I Be Concerned About Rectal Bleeding?

Medically reviewed by: Gary H. Hoffman, MD

Many people assume that rectal bleeding is simply a sign of hemorrhoids, but it can also be a sign of something much more serious, including colorectal cancer. For this reason, the American Academy of Family Physicians urges everyone who experiences bloody stools, or bleeding from the rectum or anus to talk to their doctor about this and any other symptoms.

What Causes Rectal Bleeding?

Hemorrhoids are one of the most common causes of rectal bleeding, although it is also a symptom of a number of other medical conditions that can occur in the rectum and around the anus. While a doctor’s visit is important due to many cases of colon cancer presenting with rectal bleeding, it is important to note that there is no reason to panic. Cancer is the cause of bleeding from the anus of blood in the stool in only about 1 to 2 percent of cases.

Possible causes of rectal bleeding, according to the American Society for Gastrointestinal Endoscopy include:

  • Hemorrhoids. Hemorrhoids can occur either externally or just inside your anus. When you strain to use the bathroom, pass a hard stool or rub them with toilet paper, they often bleed. Most people with hemorrhoids report seeing bright red blood, usually on the toilet paper after a bowel movement. Hemorrhoids can frequently be treated by eating a high-fiber diet, drinking plenty of fluids and minimizing time spent sitting on the toilet. Your doctor may also recommend stool softeners, laxatives or other over-the-counter treatments, depending on the cause of your hemorrhoids.
  • Polyps. Polyps can occur in the colon or the rectum, and typically cause no symptoms. Some, however, may bleed if they are irritated during a bowel movement. While they are generally benign, they are caused by abnormal cell growth. Some do, in fact, develop into colon cancer if left untreated. If your doctor finds that your rectal bleeding is caused by polyps, they will most likely be removed during a colonoscopy and biopsied to ensure they are not cancerous.
  • Rectal Ulcers. Rectal ulcers are fairly rare, but they do commonly lead to rectal bleeding when they occur. Sometimes known as solitary rectal ulcer syndrome, rectal ulcers are open sores on the lining of the rectum that are difficult to heal. They may be caused by medications, chronic constipation or frequent straining during bowel movements.
  • Proctitis. If you have inflammatory bowel disease, have undergone radiation treatments for cancer or are prescribed certain medications, you may be at an increased risk for proctitis. In addition, an infection of the rectum can also cause the lining to become inflamed. This may cause both extreme pain and blood in the stool.
  • Anal Fissures. One of the most common causes of rectal bleeding is a tear in the lining of the anus. This is known as an anal fissure. This usually present with burning and stinging during a bowel movement, and blood on the toilet paper or dripping into the bowl after using the bathroom. Constipation, hard stools and chronic diarrhea are all common causes. In most cases, anal fissures will resolve on their own fairly quickly, although they can become a chronic problem that requires invasive medical intervention.
  • Colon Cancer. Cancer of the colon is the third most commonly diagnosed type of cancer, and causes almost ten percent of all cancer deaths in the United States . If it is detected early, however, it can often be treated easily and effectively. Undergoing regular colonoscopies after age 50 and reporting any unusual rectal bleeding to your doctor can ensure any abnormalities are detected as early as possible.
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When Do I Need To See A Doctor?

For most people, even minor rectal bleeding sends alarm signals. Rectal bleeding is considered minor if you are only seeing a few spots of bright red blood, whether is is only the toilet paper, on the stool itself or dripping into the toilet bowl.

If you’re only seeing these small spots of blood on the toilet paper, it is probably OK to wait to see if it clears up on its own in a few days. If it persists for more than a few days, or you develop other symptoms, however, it is time to discuss the issue with a doctor.

More serious bleeding often makes the stool look tarry, or it may appear maroon or black. This means the bleeding is more severe, or occurring further up in the digestive tract. You should make an appointment to see a healthcare provider for evaluation as soon as possible.

Of course, rectal bleeding can be a sign of a number of serious conditions, whether it is minor or serious. For that reason, it is important to call your doctor if:

  • You’ve never before experienced rectal bleeding
  • You have bleeding heavy enough to soil your undergarments
  • The blood is dark brown or appears old
  • It has persisted for more than a few days
  • You have other symptoms, such as a change in bowel habits, a fever or unexplained weight loss

How Will My Doctor Diagnose Me?

Your doctor will begin the exam by talking to you about your symptoms, bowel habits and general health. The most common causes of rectal bleeding can typically be diagnosed with only a visual exam. This includes prolapsed internal hemorrhoids, external hemorrhoids, or anal fissures.  An internal examination may be necessary, and will involve your doctor using a gloved, lubricated finger inserted about an inch into your anus.

If the cause cannot be found through this initial examination, an anoscope or sigmoidoscope may be used to take a closer look. Both of these techniques involve insert a tube with a camera on the end into the anus. They, however, can be done in the office and do not require any special preparation.

If the cause still cannot be found, or if your doctor has reason to believe there may be a more serious issue, he may schedule a colonoscopy. The colonoscopy will require 48 to 24 hours of preparatory work to clear the bowels of all waste. Then, you will be sedated. A long, flexible tube will be used to examine the colon. Once the procedure is completed and the sedative wears off, your doctor will discuss his findings with you and can recommend a treatment regimen.

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