What Is Rectal Bleeding?
Most of the time, rectal bleeding is not caused by a serious medical condition but the only way to be sure is to see a doctor for evaluation.
What Are Symptoms of Rectal Bleeding?
Symptoms of rectal bleeding include:
- Visible blood in the toilet after a bowel movement
- Visible blood on toilet paper after wiping following a bowel movement
- Red- or maroon-colored stool
Depending on the cause, symptoms that may accompany rectal bleeding include:
- Rectal pain
- Rectal itching
- Tissue bulging around the anus
- Sensation of tearing, ripping, or burning pain during or after a bowel movement
- Leakage of stool or difficulty cleaning after a bowel movement
See a doctor for any rectal bleeding if you also experience:
What Causes Rectal Bleeding?
Common causes of rectal bleeding that are not serious include:
- Hemorrhoids: swollen blood vessels in the rectum or anus that can cause pain, itching, and sometimes bleeding
- Anal fissure: a tear in the lining of the anus that may cause a sensation of tearing, ripping, or burning pain during or after a bowel movement
Serious causes of rectal bleeding are less common and include:
- Precancerous polyps near the end of the large intestine (colon)
- Colorectal cancer
- People may ignore rectal bleeding for years, assuming it is due to hemorrhoids, only to later be diagnosed with colorectal cancer
- It is important to see a doctor for evaluation of rectal bleeding because if colorectal cancer is diagnosed early, it can often be treated
How Is Rectal Bleeding Diagnosed?
The cause of rectal bleeding is diagnosed with a patient history and physical exam. The history may include questions about the rectal bleeding (including frequency, amount, and appearance), bowel habits, family history of colorectal cancer or other cancers, and whether other symptoms such as pain accompany the bleeding. The physical exam usually involves a rectal examination.
Other tests to help diagnose the cause of rectal bleeding include
- Anoscopy to inspect the anal canal and lower rectum: this is usually an office procedure that does not require sedation
- Sigmoidoscopy to examine the rectum and most of the lower large intestine
- Colonoscopy to examine the entire colon
- Wireless capsule endoscopy
- Push enteroscopy
- Double-balloon enteroscopy
- Radionuclide scans
- Blood tests
- Complete blood cell (CBC) count
- Serum electrolyte levels
- Coagulation profile, including activated partial thromboplastin time (aptt), prothrombin time (PT), manual platelet count, and bleeding time
What Is the Treatment for Rectal Bleeding?
Treatment for rectal bleeding depends on the cause.
- Anal fissure
- Precancerous polyps
- Surgical removal of polyps (polypectomy)
- Colorectal cancer
- Avoiding medications that worsen symptoms including nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)
- Topical medications applied directly to the rectum
- 5-ASA (aminosalicylic acid or mesalamine)
- Topical or oral steroid medication
- Oral 5-ASA
- Oral steroids
- Biologics: adalimumab (Humira), infliximab (Remicade, Inflectra, Renflexis), and vedolizumab (Entyvio)
- Intravenous steroids for severe cases
- Other medications: tofacitinib or cyclosporine