Rectal bleeding 

Introduction 

How your GP investigates rectal bleeding

If your GP needs to examine you to find out what’s causing your rectal bleeding, they may carry out a rectal examination. This involves putting a gloved finger inside your rectum (bottom).

There’s no need to feel embarrassed or nervous: it’s a quick and painless procedure that GPs are used to doing.

The examination usually takes one to five minutes, depending on whether your GP finds anything unusual.

You may be referred to a hospital or specialist clinic if further examinations and tests are needed.

Rectal bleeding (bleeding from the bottom) may be caused by a swollen blood vessel or a small tear around the anus, but it can have a more serious cause and should never be ignored.

Don't let embarrassment stop you seeing your GP. You should always get rectal bleeding checked to rule out more serious causes. 

Most people with rectal bleeding will see small amounts of bright-red blood on the toilet paper after they have been to the toilet, or a few droplets that turn the water in the toilet pink. These are typical signs of piles (haemorrhoids) or a small tear (anal fissure) in the skin of your anus, the opening through which stools pass.

Both of these are very common problems, but you should not assume they are the cause of your rectal bleeding. You should still see a GP if you have these symptoms.

In general, bright-red blood means the bleeding has come from somewhere near your anus.

If the blood is darker in colour and sticky, the bleeding may have occurred higher up your digestive system. This type of bleeding can turn your faeces black or plum-coloured (known as melaena).

Having plum-coloured, dark and sticky faeces may be a medical emergency – you should see your GP immediately or contact NHS 111.

Is it bowel cancer?

Many people with rectal bleeding worry they may have bowel cancer. While rectal bleeding can be a sign of early-stage bowel cancer, other factors may also be present for your doctor to think you're at risk.

You should be urgently referred to a specialist with suspected bowel cancer if you have rectal bleeding and:

  • you are aged 40 or older and have passed looser or more frequent stools for the last six weeks
  • you are aged 60 or older and the bleeding has lasted for six weeks or more
  • your GP has found an abnormality (such as a lump) after examining you 
  • you also have anaemia, a reduced number of red blood cells
  • you have a family history of bowel cancer
  • you have ulcerative colitis

Find out more about bowel cancer and read the NICE guidelines for being referred with suspected cancer.

Common causes of rectal bleeding

Some of the most common causes of visible rectal bleeding in adults are outlined below. However, do not try to diagnose yourself, and always see your GP for a proper diagnosis.

Click on the links for more information about these causes.

Piles (haemorrhoids)

Piles are swollen blood vessels in and around the rectum. They can bleed when you have a bowel movement, which can leave streaks of bright-red blood in your stools and on the toilet paper. Piles may also cause itchiness around your anus. They often heal on their own.

Anal fissure

An anal fissure is a small tear in the skin of the anus, which can be painful as the skin is very sensitive. The blood is usually bright red and the bleeding soon stops. You may feel like you need to keep passing stools, even when your bowel is empty. It often heals on its own within a few weeks.

Anal fistula

An anal fistula is a small channel that develops between the end of the bowel, known as the anal canal or back passage, and the skin near the anus (the opening where waste leaves the body). They are usually painful and can cause bleeding when you go to the toilet. 

Angiodysplasia

Angiodysplasia is a condition in which the blood vessels in the colon (part of the large bowel) become enlarged. It is more common in older people and can cause painless rectal bleeding.

Gastroenteritis

Gastroenteritis is a viral or bacterial infection of the stomach and bowel, which your immune system will usually fight off after a few days. It can cause diarrhoea that contains traces of blood and mucus, as well as other symptoms such as vomiting and stomach cramps.

Diverticula

Diverticula is where small bulges form in the lining of your lower bowel. These contain weakened blood vessels that can burst and cause sudden, painless bleeding (you may pass quite a lot of blood in your stools). 

Colon cancer and polyps

Colon cancer (a type of bowel cancer) is a common cancer and the reason why you should always get checked by your GP if you have rectal bleeding. The only symptom may be rectal bleeding in the early stages, so don't ignore it. Colon cancer can be more easily treated if diagnosed at an early stage.

Colon cancer starts as little growths called polyps, removing these early can prevent the cancer taking hold.

Cancer of the rectum

Cancer of the rectum is a type of bowel cancer that usually affects older people, but can only be ruled out after seeing your GP.

Less common causes of rectal bleeding

Some of the more unusual causes of rectal bleeding include:




Page last reviewed: 29/01/2013

Next review due: 29/01/2015

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Comments

The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

kazza77 said on 27 June 2014

My Daughter has been suffering for more than 2 years she is only 18. She is being treated for constipation and muscle weakness. Her symptoms are extreme constipation & diarrhoea & bleeding & abdominal pain. She has seen a specialist and been to Bristol for tests for her muscles, and has a barium x-ray. She has been prescribed some strong drugs to stimulate her muscles to help her go to the toilet, but they left her in more pain than she started with....now were back to square one, and her bleeding and diarrhoea are getting worse :(

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snobear said on 05 March 2014

I have had all these problems for years. Doctors always dismiss them as hemoroids. I went to a Natural Medicine Dr. and was tested for Candida Albicans. I started pre and probiotics and Oregano Oil and some other natural pills and my problems have subsided immensly. The bleeding is less frequent. I feel almist "normal" again.It was like waking up from a bad dream when I found out about Candida.

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Bekx14 said on 03 November 2013

I have had this problem for around 6 years now and I'm only 27. I have had piles and anal fissures and skin tags on and off for this period of time. I had them removed 3 times and then I had a camera inserted to see why the problem keeps returning but they didn't find anything. A month ago I had my fourth operation to remove my fissure again and I have still had bleeding ever since. Sometimes I can even bleed trying to go but nothing happens except lots of blood in the toilet. I don't know what to do next because nothing's working and the doctors don't seem to be able to fix me :-( .

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MR1991 said on 19 July 2013

I've had this problem for 3 years now & the doctors won't do anything. I've been to hospital twice for a colonoscopy. 1st time they didn't find anything & told me its just IBS. 2nd time they said its just hemoroids. I'm anaemic, so blood loss for me isn't the best. I keep telling the doctors that its worse, that the blood is darker & even clotted but they still won't do anything. I don't have bleeding all the time, it could be once a month or even 2 weeks a month. It's stopped me from wanting to go just incase I need the bathroom & it's happens.

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minipin05 said on 14 June 2013

I have had bleeding and pain for several weeks getting progressively worse I went to my G.P on the 21-05-2013
she was referring me to a g astrologist . I have heard nothing three weeks on so I rang the surgery today only to find the referral was being done today three weeks on. The secretary I spoke to was apologetic and made me an electronic appointment for the 22nd of August but has promised she will get the doctor to ring me on Monday after surgery as the blood loss is getting more in amount.
I am very concerned that should this turn out to be the worst I have already lost 5 weeks it took 2 weeks to get my first appointment in the first place. Even though the secretary has apologized and can't answer why it was not done before it has left me frightened and worried.
I also made another appointment to see the same doctor last week but that is not until July 3rd how is anyone supposed to go an act fast in case

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Marc70 said on 27 December 2012

My GP did not urgently refer me to a specialist when I went to him earlier this year with these symptoms -despite fitting the criteria?

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User74428 said on 01 November 2012

This was helpful, but it doesn't explain everything. I was diagnosed with fissures last year, and although most of the symptoms have cleared up (loose stools, excruciating pain in the anus, spasms etc) I still get problems with bleeding once or twice a month (most often before period). Also, I have to avoid very spicy foods, mostly chilli. Do hormones play a part in this? I should also say when the severe problems started I was breastfeeding and also started jogging a couple of weeks before.

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