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Claremont Medical Practice

webGP -Rectal bleeding

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Learn more about rectal bleeding: overview

Rectal bleeding (bleeding from the bottom) is often noticed as small amounts of bright-red blood on toilet paper or a few droplets that turn the water in the toilet pink.

In general, bright-red blood means the bleeding has come from somewhere near your anus and is a typical sign of piles (haemorrhoids) or a small tear (anal fissure) in the skin of your anus.

Although these are common problems, don't let embarrassment stop you seeing your GP. You should always get rectal bleeding checked to rule out more serious causes. Around 10% of adults experience rectal bleeding every year in the UK.

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.

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 bottom (rectum).

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.

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're aged 40 or older and have passed looser or more frequent stools for the last six weeks
  • you're 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

Bowel cancer is sometimes called colon or rectal cancer, depending on where the cancer starts.

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, don't 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) – 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 – 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 – 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're usually painful and can cause bleeding when you go to the toilet.
  • angiodysplasia – abnormal blood vessels in the gastrointestinal tract, which can cause bleeding. It's more common in older people and can cause painless rectal bleeding.
  • gastroenteritis – a viral or bacterial infection of the stomach and bowel, which your immune system usually fights off after a few days. It can cause diarrhoea containing traces of blood and mucus, as well as vomiting and stomach cramps.
  • diverticula – small bulges 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).
  • bowel cancer (colon or rectal cancer) – you should always get checked by your GP if you have rectal bleeding. The only symptom of bowel cancer may be rectal bleeding in the early stages, so don't ignore it. Bowel cancer can be treated more easily if it's diagnosed at an early stage.

Less common causes of rectal bleeding

Some of the more unusual causes of rectal bleeding include:

  • anticoagulant drugs – such as warfarin or aspirin, which are taken to reduce your chance of a blood clot but can sometimes cause internal bleeding.
  • inflammatory bowel disease – such as Crohn's disease or ulcerative colitis. These long-term conditions cause the lining of the bowel to become inflamed. Crohn's disease affects the gut higher up, whereas ulcerative colitis affects the large bowel and rectum further down. Both tend to cause bloody diarrhoea.
  • bowel polyps – small growths on the inner lining of the colon or rectum. These are common and often don't cause symptoms, but may lead to a small amount of blood in your stool.
  • sexually transmitted infections (STIs) – any sexual activity involving the anal area can spread STIs, which may sometimes lead to rectal bleeding. Read more about the risks of anal sex.

Content Supplied by NHS Choices

Learn more about rectal bleeding: treatment

Haemorrhoids (piles) often clear up by themselves after a few days. However, there are many treatments that can reduce itching and discomfort.

Making simple dietary changes and not straining on the toilet are often recommended first.

Creams, ointments and suppositories, which you insert into your bottom, are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

If more intensive treatment is needed, the type will depend on where your haemorrhoids are in your anal canal – the lower third closest to your anus, or the upper two-thirds. The lower third contains nerves that can transmit pain, while the upper two-thirds do not.

Non-surgical treatments for haemorrhoids in the lower part of the canal are likely to be very painful, as the nerves in this area can detect pain. In these cases, haemorrhoid surgery will usually be recommended.

The various treatments for haemorrhoids are outlined below. You can also read a summary of the pros and cons of haemorrhoid treatments, allowing you to compare your treatment options.

Dietary changes and self care

If constipation is thought to be the cause of your haemorrhoids, you need to keep your stools soft and regular so you don't strain when going to the toilet.

You can do this by increasing the amount of fibre in your diet. Good sources of fibre include wholegrain bread, cereal, fruit and vegetables.

You should also drink plenty of water and avoid caffeine.

When going to the toilet, you should:

  • avoid straining to pass stools, as it may make your haemorrhoids worse
  • use baby wipes or moist toilet paper, rather than dry toilet paper, to clean your bottom after passing a stool
  • pat the area around your bottom rather than rubbing it

Read more about preventing constipation.

Medication

Over-the-counter topical treatments

Various creams, ointments and suppositories are available from pharmacies without a prescription. They can be used to relieve any swelling and discomfort.

These medicines should only be used for five to seven days at a time. They may irritate the sensitive skin around your anus if you use them longer than this. 

Any medication should be combined with the diet and self care advice discussed above.

There's no evidence to suggest that one method is more effective than another.

Ask your pharmacist for advice about which product is most suitable for you, and always read the patient information leaflet that comes with your medicine before using it.

Don't use more than one product at once.

Corticosteroid cream

If you have severe inflammation in and around your back passage, your GP may prescribe corticosteroid cream, which contains steroids.

You shouldn't use corticosteroid cream for more than a week at a time as it can make the skin around your anus thinner and the irritation worse.

Painkillers

Common painkilling medication, such as paracetamol, can help relieve the pain of haemorrhoids.

However, if you have excessive bleeding, avoid using non-steroid anti-inflammatory drugs (NSAIDs), such as ibuprofen, as they can make rectal bleeding worse.

You should also avoid using codeine painkillers as they can cause constipation.

Your GP may prescribe products that contain local anaesthetic to treat painful haemorrhoids. Like over-the-counter topical treatments, these should only be used for a few days because they can make the skin around your back passage more sensitive.

Laxatives

If you're constipated, your GP may prescribe a laxative. Laxatives are a type of medicine that can help you empty your bowels.

Non-surgical treatments

If dietary changes and medication don't improve your symptoms, your GP may refer you to a specialist. They can confirm whether you have haemorrhoids and recommend appropriate treatment.

If you have haemorrhoids in the upper part of your anal canal, non-surgical procedures such as banding and sclerotherapy may be recommended.

Banding

Banding involves placing a very tight elastic band around the base of your haemorrhoids to cut off their blood supply. The haemorrhoids should then fall off within about a week of having the treatment.

Banding is usually a day procedure that doesn't need an anaesthetic, and most people can get back to their normal activities the next day.

You may feel some pain or discomfort for a day or so afterwards. Normal painkillers are usually adequate, but your GP can prescribe something stronger if needed.

You may not realise that your haemorrhoids have fallen off, as they should pass out of your body when you go to the toilet.

If you notice some mucus discharge within a week of the procedure, it usually means that the haemorrhoids have fallen off.

Directly after the procedure, you may notice blood on the toilet paper after going to the toilet. This is normal, but there shouldn't be a lot of bleeding.

If you pass a lot of bright red blood or blood clots, go to your nearest accident and emergency (A&E) department immediately.

Ulcers can occur at the site of the banding, although these usually heal without needing further treatment.

Injections (sclerotherapy)

A treatment called sclerotherapy may be used as an alternative to banding.

During sclerotherapy, a chemical solution is injected into the blood vessels in your back passage. This relieves pain by numbing the nerve endings at the site of the injection.

It also hardens the tissue of the haemorrhoid so a scar is formed. After about four to six weeks, the haemorrhoid should decrease in size or shrivel up.

You should avoid strenuous exercise for the rest of the day after having the injection. 

You may experience minor pain for a while and may bleed a little. You should be able to resume normal activities, including work, the day after the procedure.

Electrotherapy

Electrotherapy, also known as electrocoagulation, is another alternative to banding for people with smaller haemorrhoids.

During the procedure, a device called a proctoscope is inserted into the anus to locate the haemorrhoid. 

An electric current is then passed through a small metal probe placed at the base of the haemorrhoid, above the dentate line. The specialist can control the electric current using controls attached to the probe.

The aim of electrotherapy is to cause the blood supplying the haemorrhoid to thicken, which shrinks it. If necessary, more than one haemorrhoid can be treated during each session.

Electrotherapy can either be carried out on an outpatient basis using a low electric current, or a higher dose can be given while the person is under a general anaesthetic or spinal anaesthetic.

You may experience some mild pain during or after electrotherapy, but in most cases this doesn't last long. Rectal bleeding is another possible side effect of the procedure, but this is usually short-lived.  

Electrotherapy is recommended by the National Institute for Health and Care Excellence (NICE), and has been shown to be an effective method of treating smaller haemorrhoids.

It can also be used as an alternative to surgery for treating larger haemorrhoids, but there's less evidence for its effectiveness.

Surgery

Although most haemorrhoids can be treated using the methods described above, around 1 in every 10 people will eventually need surgery.

Surgery is particularly useful for haemorrhoids that have developed below the dentate line – unlike non-surgical treatments, anaesthetic is used to ensure you don't feel any pain.

There are many different types of surgery that can be used to treat haemorrhoids, but they all usually involve either removing the haemorrhoids or reducing their blood supply, causing them to shrink.

Read more about surgery for haemorrhoids.

Content Supplied by NHS Choices