Rectal bleeding: causes, symptoms and treatment options
Rectal bleeding can be a worrying symptom, but it is often caused by conditions that are treatable and sometimes easily managed.
In this guide, consultant general and colorectal surgeon Mr Paul Skinner explains what rectal bleeding is, why it occurs, and the steps for seeking treatment.
What is rectal bleeding?
Rectal bleeding refers to any blood passed from the anus. Blood may appear bright red, dark red, or mixed with stool. The volume can range from small streaks on toilet paper to larger amounts, and the frequency can be occasional or persistent. While concerning, not all rectal bleeding indicates a serious condition.
Common causes of rectal bleeding
Several conditions can lead to rectal bleeding, ranging from minor irritations to more serious disorders.
Haemorrhoids
Haemorrhoids, or piles, are swollen blood vessels in the rectum or anus. They are a very common cause of bright red blood, usually noticed on toilet paper or in the toilet bowl. Causes include constipation, straining during bowel movements, pregnancy, or prolonged sitting.
Anal fissures
An anal fissure is a small tear in the lining of the anus, causing sharp pain during bowel movements and bright red bleeding. Fissures are often caused by passing hard stools and may be accompanied by itching or discomfort.
Diverticular disease
Diverticular disease occurs when small pouches (diverticula) form in the lining of the colon. These pouches can bleed, producing painless, bright red rectal bleeding. It is more common in older adults and may occur intermittently.
Polyps and colorectal cancer
Polyps are benign growths in the colon or rectum that can bleed. Some polyps can develop into colorectal cancer if left untreated. Rectal bleeding with changes in bowel habits, unexplained weight loss, or persistent abdominal pain should always be investigated promptly.
Inflammatory bowel disease
Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn’s disease, can cause inflammation and ulceration in the bowel, leading to rectal bleeding. Other symptoms may include diarrhoea, abdominal pain, and fatigue.
When to seek medical advice
Rectal bleeding should not be ignored, particularly if persistent, painful, or associated with other concerning symptoms, such as:
- Unexplained weight loss.
- Changes in bowel habits.
- Dizziness or fainting.
- Blood mixed with stools rather than on the surface.
A colorectal specialist can perform a thorough assessment, which may include a physical examination and colonoscopy to determine the cause.
Treatment options
Treatment depends on the underlying cause. Simple lifestyle adjustments, such as increasing dietary fibre, staying hydrated, and avoiding straining, can often relieve haemorrhoids or mild anal fissures. More complex cases may require procedures such as rubber band ligation, minimally invasive surgery, or medication. Early diagnosis is particularly important for polyps or colorectal cancer, where timely intervention improves outcomes.
Although rectal bleeding can be alarming, it is frequently caused by conditions that are treatable. Persistent or significant rectal bleeding warrants prompt consultation with a colorectal specialist to ensure correct diagnosis and effective management.
