Bleeding From The Bottom Rectal Bleeding

Overview

Rectal bleeding means blood coming from your back passage (the anus) or the lower part of your bowel. You might notice bright red blood on the toilet paper, in the toilet bowl, or mixed in with your poo. Sometimes it is a small streak that stops on its own; sometimes there is more. Most of the time the cause is something minor and easy to treat, such as a small tear or a pile, but it is always worth checking with a doctor so the cause is known for certain.

Yes. Rectal bleeding is one of the most common reasons people see their doctor about their bowels. Many adults have had a small amount of bleeding at some point, often from piles or from straining on the toilet.

It can affect anyone at any age. It is more common in adults, especially people who are constipated or pregnant, and it becomes more common as people get older. Babies and children can also have small amounts of bleeding, usually from a tiny tear or a hard poo.

Symptoms

Common symptoms

• Bright red blood on the toilet paper after wiping
• Blood in the toilet bowl, or drips after you finish
• Blood on the surface of the poo, or mixed in with it
• Pain or a burning feeling when passing poo, which is common with a small tear
• Itching, soreness or a lump around the back passage, which is common with piles
• Small amounts of blood staining your underwear

Symptoms in children

• Small streaks of bright red blood on the toilet paper, often from a small tear caused by a hard poo
• Pain or crying when passing a poo, which can be a sign of constipation
• Blood mixed with mucus or loose poo, which should be checked by a doctor
• Any bleeding in a baby should always be checked by a doctor

Symptoms in older adults

• Bleeding together with a change in bowel habit, such as looser poo or needing to go more often
• Blood that looks dark, or black tarry stools, which can come from higher up in the bowel
• Tiredness, breathlessness or looking pale, which can be signs of low iron (anaemia) from slow blood loss
• Bleeding while taking blood-thinning medicine, which should always be checked

Causes

Main causes

• Piles (haemorrhoids): swollen veins in the back passage that can bleed when you strain
• Anal fissure: a small tear in the skin around the back passage, often caused by hard poo
• Constipation and straining, which irritate the area
• Diverticular disease: small pouches in the bowel wall that can bleed
• Inflammation of the bowel, such as ulcerative colitis or Crohn's disease
• Polyps: small growths in the bowel that can bleed; most are harmless but they need checking
• Bowel cancer: much less common, but this is exactly why bleeding should always be checked
• Infections that cause diarrhoea, which can irritate the bowel
• Blood-thinning medicines, which can make bleeding more likely

Risk factors

• Being constipated or passing hard, dry poo
• Being pregnant, when pressure and hormones make piles more likely
• Getting older, especially over 50
• A family history of bowel cancer or bowel polyps
• Inflammatory bowel disease
• A low-fibre diet, not drinking enough, and little physical activity
• Taking blood thinners or regular anti-inflammatory painkillers
• Smoking and drinking a lot of alcohol

When to see a doctor

See a doctor urgently if:

• The bleeding is heavy, or you feel dizzy, faint or unwell
• You have severe tummy pain
• The bleeding has not settled after a few days
• You are bleeding and also losing weight without trying
• You feel very tired or short of breath

Book a routine appointment if:

• You noticed a small amount of bright red blood once or twice and otherwise feel well
• You have itching, soreness or a lump that is not settling
• You want advice about constipation or piles

Diagnosis

Your doctor will start by asking questions: when the bleeding started, what it looks like, whether it hurts, and whether your bowel habits have changed. They may ask about your family history and any medicines you take. Then they will usually examine your tummy and may look at your back passage with a gloved finger, which takes seconds and helps them feel for lumps, piles or tenderness. Depending on what they find, they may arrange simple tests or refer you to a specialist.

Tests that may be done

• Blood tests, including a check for low iron (anaemia)
• A stool sample test that looks for hidden blood
• A rectal examination, which is a quick finger check of the back passage
• Sigmoidoscopy or colonoscopy: a thin camera examines the inside of the bowel, and you are usually offered medicine to keep you comfortable
• A scan of the tummy in some cases

What to expect at your appointment

Most people need only a conversation and a short examination. If you are referred for a camera test, you will be given instructions about preparing your bowel beforehand, and someone can usually go with you. Waiting for results is the hardest part for many people, so ask when to expect them and who to contact if you have not heard.

Treatment

Treatment depends on the cause, but it usually starts with simple measures. Many causes settle with changes to diet and toilet habits, and with treatment for constipation. Your doctor will explain what they think is happening and what to try next. Nothing is done without your agreement, and you can ask questions at any point.

Self-care at home

• Drink plenty of water and eat fibre-rich foods such as fruit, vegetables, wholegrains and beans
• Go to the toilet when you feel the urge, and avoid straining or sitting there for a long time
• Keep the area clean and gently pat it dry rather than rubbing
• Avoid perfumed wipes or soaps around the back passage
• A warm bath can ease soreness from a small tear or piles
• Stay active, as regular walking helps keep bowels moving
• Do not stop any prescribed medicine without speaking to your doctor or pharmacist first

Medical treatments

Your doctor may suggest treatments to soften the poo and ease pain, creams or ointments to soothe the area, or simple procedures done in the clinic to treat piles, such as a small band placed around them. If the cause is inflammation or an infection, specific treatment is available. If a polyp is found, it can usually be removed during the camera test. Your healthcare team will explain the options, the benefits and the risks, and agree a plan with you.

When is surgery considered?

Surgery is only needed for a small number of people, for example when piles keep bleeding despite other treatments, when a tear does not heal, or when part of the bowel needs treatment. Your specialist would discuss this with you in detail, including what recovery involves.

Living with this condition

For most people, rectal bleeding is a short episode rather than a long-term condition. Once the cause is known and treated, you can usually get back to normal. If you have a long-term bowel condition, regular follow-up helps keep it under control.

Lifestyle tips

• Build a routine around regular meals and gentle movement to keep your bowels regular
• Keep a simple note of bleeding and bowel habits if your doctor asks you to monitor them
• Take any prescribed medicine as agreed, and ask your pharmacist about side effects
• Attend follow-up appointments, including bowel screening invitations when they arrive

Diet and exercise

Aim for a balanced diet with plenty of fibre and fluids, and build up fibre slowly so your body can adjust. Regular activity, such as a daily walk, helps keep the bowel working well. There is no special diet that suits everyone, so notice what helps you and ask for advice if you are unsure.

Mental health and emotional wellbeing

It is very common to feel anxious when you see blood, and worry can make you check repeatedly or avoid the toilet. That is understandable. Talking to someone you trust, or to your doctor, often helps. If worry is affecting your sleep, mood or daily life, please tell your doctor. If you ever feel overwhelmed or unsafe, contact your local crisis line or emergency services right away.

Prevention

Not all causes can be prevented, but many of the most common ones can be made much less likely by keeping your poo soft and easy to pass, and by taking part in bowel screening when you are invited.

Screening programmes

Many countries run bowel cancer screening programmes, often using a home stool test, and some also offer a camera test. In the UK, the NHS bowel screening programme invites people from around their early fifties onwards; the exact age and test can vary between nations, so check your invitation or ask your GP. Screening is for people without symptoms, so if you already have bleeding, see your doctor rather than waiting for a screening test.

Complications

If left untreated

• Ongoing blood loss can lead to low iron (anaemia), causing tiredness and breathlessness
• Piles or a tear can become more painful and slower to heal
• A serious cause, such as a polyp or bowel cancer, could be found later than it needed to be
• Ongoing worry and avoiding the toilet can make bowel habits worse

Long-term outlook

The outlook is good for most people. Common causes clear up with simple treatment, and even when something more serious is found, spotting it early usually means treatment works better. The single most helpful thing you can do is get the bleeding checked rather than waiting.

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