Rectal Bleeding

What is rectal bleeding?

You have rectal bleeding when you have bright red blood on or in a bowel movement, on the toilet tissue after wiping, or in the toilet bowl water. It is a common problem for adults of all ages.

What is the cause?

There are many causes of rectal bleeding. The 2 most common causes are anal fissures and hemorrhoids. Both of these problems can be caused by constipation.

• Anal fissures are tiny tears, usually less than 1/2 inch long, in the skin of the anus. Bowel movements pass out of the body through the anus. Fissures are most often caused by hard bowel movements that tear the skin as they pass through the anus.
• Hemorrhoids are swollen veins in the lower rectum and anus. They may be external, which means they can be seen outside the anus. Or they may be internal, which means they are up inside the rectum and cannot be seen without special instruments.

Diverticula in the colon are a fairly common cause of rectal bleeding in middle-aged and older adults. Diverticula are fingerlike pouches at weak points in the wall of the colon. Bowel movements can get caught in the pouches. The pouches may become irritated or infected and bleed.

Other possible causes of rectal bleeding are:

• Infection in the intestines. In this case the bloody diarrhea usually lasts for 1 to 3 days and then is gone.
• Inflammatory bowel disease. This disease is an irritation of the lining of the colon. It causes belly pain, diarrhea, and mucus in your bowel movements as well as bleeding.
• Bleeding in the upper digestive system. When this happens--for example, because of an ulcer--the bleeding is usually heavy and constant. It is a medical emergency.

Colon cancer is not a common cause of blood that you can see. It is more common for colon cancer to cause blood in the bowel movement that cannot be seen. Special tests of the bowel movement are needed to find blood caused by cancer.

What are the symptoms?

Rectal bleeding is bright red blood in or on a bowel movement, on toilet tissue after wiping, or in the toilet water. You may or may not have some pain when you have the bowel movement.

• If you have external hemorrhoids, you may have pain when you sit.
• Anal fissures may cause pain as you pass the bowel movement and the skin is stretched.
• If you have diverticula, you may have no symptoms or you may have bouts of abdominal pain. Sometimes you may have bouts of pain with fever for a day or two if the diverticula are inflamed or infected.
• When colon cancer is the cause of bright red bleeding, it may be your only symptom or you may have other symptoms. These other symptoms may include diarrhea, constipation, abdominal pain, weight loss, loss of appetite, and tiredness.

How is it diagnosed?

If you have rectal bleeding, your healthcare provider will ask about your medical history and about any other symptoms you may have. You will have a rectal exam to look for anal fissures, external hemorrhoids, and tumors. A sample of bowel movement may be checked for blood. Your provider may put a small metal or plastic tool called an anoscope into the rectum an inch or two to look for internal hemorrhoids or other causes of bleeding in the rectum.

If these exams do not find a cause for the bleeding, and especially if you are at risk for colon cancer because of your age or family history, you may have a special exam called a sigmoidoscopy or a colonoscopy. This exam, done with a slim flexible tube with a light and tiny camera, can also be used to look for other problems such as diverticula in the colon. A special type of X-ray called a barium enema is another way to look for cancers and diverticula.

You may also have blood tests to look for anemia and signs of inflammation.

How is it treated?

The treatment for rectal bleeding depends on the cause. For simple problems such as fissures and hemorrhoids, you may need to increase the fiber in your diet and make other lifestyle changes to prevent constipation. Your healthcare provider will discuss with you other treatments if something else is causing rectal bleeding.

How can I take care of myself?

• When you have bleeding, see your healthcare provider to make sure it is not a symptom of serious disease. Rectal bleeding is not normal, even though it’s a common problem. If your bleeding is nonstop or in large amounts, you should seek emergency care.
• Follow your provider's instructions carefully.
• If you are not getting better, let your provider know, so you can try a different treatment.

How can I help prevent rectal bleeding?

Try to keep the lower intestine as healthy as possible.

• Eat a healthy diet with lots of high-fiber foods, such as whole grains, fresh fruits and vegetables.
• Drink plenty of fluids.
• Get regular exercise.

These activities help the intestines work better and help prevent constipation, hemorrhoids, and diverticula.