Rectal bleeding – what is it?

Bleeding from your anus (bottom or butthole) can be worrying, but there are lots of common causes, and many are not serious. Find out why it can happen and what to do. 

When to get emergency help

Common causes of rectal bleeding and treatments

Can you prevent it? 

Bleeding from your anus (bottom or butthole) can be worrying, but there are lots of common causes, and many are not serious. Find out why it can happen, and what to do if you see blood in your stool (poop), on toilet tissue, or in the toilet after a bowel movement (poop). 

It may not be something we often talk about, but bleeding from the anus (bottom or butthole) is common – it’s thought up to 1 in 3 of us will experience it at some point.

This problem is usually known as rectal bleeding because it’s generally thought that the blood comes from your rectum, the lower part of your large intestine.

Rectal bleeding can show up in different ways. Blood is usually bright red, but can be darker. You may notice it:
- in your stool (poop)
- on the toilet tissue after you’ve had a bowel movement
- in the toilet bowl.

Most of the time, it’s caused by a minor problem such as hemorrhoids (piles), or fissures (tears in your anus). A little one-off bleeding doesn’t usually indicate a serious problem, and often clears up by itself. But some causes are more serious, so you should always get rectal bleeding checked out by your doctor.

Some foods can change the color of your stool – beetroot, tomatoes, and blueberries can make it look red or purple, while iron supplements may give it a dark green or black color. So, if you notice a sudden color change, try to remember what you’ve eaten.


## When to get emergency help
Get emergency treatment right away if:
- bleeding is non-stop
- there’s a lot of blood – it may turn the water in the toilet red, or you may see big blood clots. 

Go to an urgent treatment center if:
- your poop is dark red or black
- you have bloody diarrhea
- you feel unwell and have a fever (high temperature)
- you have recently visited another country
- you have eaten foods which may have caused a bacterial infection.

Make an appointment with your doctor if:
- you’ve had blood in your poop for 3 weeks or more
- your poop has been different – longer, thinner, or softer, for at least 3 weeks
- you’re in a lot of pain around the bottom
- you have a pain or lump in your belly
- you’ve been feeling more tired than usual
- you’ve lost weight for no clear reason. 

Lots of people feel embarrassed about discussing rectal bleeding with healthcare professionals, but remember it’s a common problem. 

Your doctor is likely to ask questions about your symptoms and medical history. They may check your rectum with a gloved finger, take a stool sample, and might refer you for further tests.


Get help with this

## Common causes of rectal bleeding and treatments
The bleeding itself and any other symptoms may give some information about the underlying cause that’s making this happen. Most causes of rectal bleeding are minor and can be treated, but some are more serious and need medical attention. So don’t self-diagnose – your healthcare professional can check. 

### Hemorrhoids 
Also known as piles, these are swollen veins near your anus (butthole), and may be the most common cause of rectal bleeding. They can be linked to [constipation](https://www.livehealthily.com/health-library/conditions/constipation) – if you strain hard when having a bowel movement, the skin may break, causing them to bleed.

#### What are the symptoms? 

Blood from hemorrhoids is usually bright red. Other symptoms may include [anal pain](https://www.livehealthily.com/health-library/symptoms/anal-pain), itching, and lumps around your anus (butthole).

#### Treatments
Hemorrhoids should clear up by themselves in a few days, but your healthcare professional can offer treatments that may help to ease symptoms, such as stool softeners, and lotions to relieve the pain or itching. They may also give you advice for easing symptoms at home, and for preventing constipation, which may reduce your risk of having hemorrhoids again – such as exercising regularly and eating more fibre-rich foods.

### Anal fissures
An [anal fissure](https://www.livehealthily.com/health-library/conditions/anal-fissure) is a small tear or sore in the lining of your anus (butthole). Like hemorrhoids, it’s often linked to constipation, as the skin may tear when you’re straining to pass a stool (poop).

#### What are the symptoms? 

Sharp pain during bowel movements, which may continue as deeper, burning pain for a few hours afterwards. You might notice bright red blood on toilet tissue or in your poop.

#### Treatments

 Most anal fissures heal naturally in a few weeks, but see your doctor to rule out other causes. They may offer treatment to help the fissure heal faster, and give you lifestyle advice to prevent constipation. For example, your doctor may recommend increasing fibre in your diet, drinking more water, and being more active.  Some people may need surgery if fissures don’t get better, or keep coming back.

### Anal fistulas
An [anal fistula](https://www.livehealthily.com/health-library/conditions/anal-fistula) is a small channel that develops between the inside of the anus (bottom opening) and the skin just outside, caused by an infection.

#### What are the symptoms?
Constant anal pain, bleeding, and pus, especially when you have a bowel movement. The skin around your anus may also be irritated.

#### Treatments
Most fistulas need surgery, so talk to your doctor if you recognize these symptoms.

### Diverticular disease
Diverticula are small pouches or pockets that often form in the lining of your bowel as you get older. [Diverticulitis](https://www.livehealthily.com/health-library/conditions/diverticular-disease-and-diverticulitis) can develop if these pouches get infected.

#### What are the symptoms? 
Diverticular disease can lead to blood in your poop, bloating, abdominal pain, and constipation or diarrhea. If an infection develops, you may have more serious, ongoing pain, a fever (high temperature), and mucus coming out of your anus. Infection can weaken the blood vessels inside the pouches – if they burst, it may result in heavy rectal bleeding.

#### Treatments
Your healthcare professional may recommend pain relief, laxatives to ease constipation, and antispasmodic medicines to help stomach cramps. If you have an infection (diverticulitis), they may prescribe antibiotics to clear it.

### Other causes of rectal bleeding
Less common causes may include:
- bowel polyps – these small growths in the rectal lining are very common, usually harmless, and don’t always cause symptoms. But larger polyps may sometimes lead to bleeding from your anus (butthole)
- sexually transmitted infections – rectal bleeding without lumps, itching or pain, could be a result of infections such as genital warts, or [chlamydia](https://www.livehealthily.com/health-library/conditions/chlamydia)
- side effect of some medication – treatments to help prevent blood clots, like warfarin, apixaban or aspirin, can cause bleeding in the stomach or bowel
- inflammatory bowel disease – IBD conditions, such as [Crohn’s](https://www.livehealthily.com/health-library/conditions/crohns-disease) or [ulcerative colitis](https://www.livehealthily.com/health-library/conditions/ulcerative-colitis), can inflame the lining of the bowel and lead to bloody diarrhea
- bowel cancer – along with bleeding, you may also have other symptoms, including a change in bowel habits, abdominal pain, unexplained weight loss, and tiredness. Less than 4% of rectal bleeding cases are caused by bowel cancer, but it’s important to get checked out if you have these symptoms for more than 3 weeks.


## Can you prevent it? 
The causes of rectal bleeding can’t always be prevented, but it may be helpful to try to avoid constipation and straining. Your healthcare professional can give you advice that’s best for you, but generally, you could try to:
- eat a balanced diet, including fruit that contains sorbitol, a natural laxative, such as raisins, grapes, strawberries, apricots, and apples
- drink plenty of fluids
- avoid alcohol
- add oats, flaxseed, or wheat bran to your diet
- try to have a regular toilet routine, giving yourself enough time to have bowel movements (poop)
- don’t delay going to the toilet if you need a bowel movement
- stay active –  a daily walk or jog may help to keep you regular. 


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References

Roz Ryan

Charlotte Haigh

Dr Emily Blount

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Bleeding from your anus (bottom or butthole) can be worrying, but there are lots of common causes, and many are not serious. Find out why it can happen and what to do.