Causes Of Bleeding From The Rectum

Blood In The Stool Is Never Normal, And Should Always Be Discussed With A Doctor

Seeing blood in the toilet bowl, in your stool, or on toilet paper can be quite startling. Bleeding in the colon (the large intestine) is not a symptom that should be ignored because it is never considered "normal." After the initial shock of having blood in your stool wears off, you will want to know what is causing the bleeding.

If you have other symptoms to go along with the rectal bleeding, the cause might seem obvious, but that doesn't mean you should go it alone. Blood in the stool should always be discussed with a physician, even if it has happened previously, or even if you've been diagnosed with any of the conditions listed below before. In the meantime, while you're waiting for that doctor appointment, find out more about some of the common conditions that could cause visible bleeding from the rectum.

Hemorrhoids

Hemorrhoid
Internal and external hemorrhoids can cause blood in the stool. Image © A.D.A.M.

One very common cause of bleeding from the rectum is hemorrhoids. Hemorrhoids are actually veins in the rectum that have become swollen. They may cause pain, itching, and bright red blood on the stool or on the toilet paper, although many do not cause any symptoms at all. Hemorrhoids are typically not serious and can be treated at home. They should be investigated by a physician in the case that they are causing a large amount of bleeding or if they aren't getting any better after being treated.

Remember, when there is visible blood in the toilet, coating the stool or on the toilet paper, you should be seen by a doctor. This is because there is a possibility of losing so much blood that the situation becomes dangerous, or that the bleeding is from a serious condition like inflammatory bowel disease (IBD) or cancer.

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Diverticular Disease (Diverticulitis)

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Diverticular disease could cause bleeding in the digestive tract. Image © A.D.A.M.

Diverticular disease is very common; as many as half of all people over age 60 have signs of diverticular disease. Diverticulosis is the presence of weak spots on the wall of the large intestine that develop into pockets. These outpouchings are called diverticula (a singular outpouch is called a diverticulum), and they generally don't produce any symptoms at all. You might not know they were there unless one or more of them get infected, which is then called diverticulitis. Diverticulitis might make a person very sick and cause abdominal pain. In rare cases, the diverticula might bleed. The blood could be found in or on the stool, or bleeding could happen even without a bowel movement. Diverticular disease could cause quite a bit of bleeding and might or might not need treatment, but people with this condition should always see a physician if there is bleeding.

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Anal Fissures

Anal Fissure
An anal fissure can cause bleeding and painful bowel movements. Image © National Institutes of Health

An anal fissure could be a complication of Crohn's disease or of childbirth, or it could be caused by hemorrhoids that have ulcerated or straining from severe constipation. This tear in the anal canal could cause bright red blood in the stool or on the toilet paper, but also pain during bowel movements. Most fissures are acute, will respond to non-invasive therapies that can be done at home and won't come back. A fissure that becomes chronic and is resistant to heal may need more intensive treatment, such as surgery.

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Polyps and Colon Cancer

Polyp On A Short Stalk
A colon polyp with a short stalk. Image © Stephen Holland, M.D., Naperville Gastroenterology, Naperville, IL

One source of bleeding from the rectum is colon cancer. Colon cancer starts with polyps -- outcroppings on the inside wall of the colon. Bleeding from colon polyps might not be visible to the naked eye, and most polyps don't bleed at all. Therefore, polyps could be growing in the colon without causing any signs or symptoms at all. Bleeding is a sign of colon cancer, but it might not appear until the cancer is in a more advanced stage. When polyps are removed during a colonoscopy, there is no chance of them developing into cancer.

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Inflammatory Bowel Disease (IBD)

Female doctor examining a young man
erel photography/E+/Getty Images

Rectal bleeding due to IBD is more common with ulcerative colitis than it is with Crohn's disease. Bleeding tends to be a hallmark sign of ulcerative colitis because, in this form of IBD, the inflammation begins at the end of the colon, in the rectum. Crohn's disease in the colon, particularly in the rectum, could also lead to visible blood on or in the stool. The blood coming from the ulceration in the colon that is from these diseases is often fresh, so it tends to be a brighter red in color. In the case of ulcerative colitis, there might be bowel movements that are mainly just blood. Blood from higher up in the digestive tract tends to be darker in color and might not be as visible in the stool.​

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