Rectal Bleeding

Bleeding from the bottom or anus commonly known as rectal bleeding is a very common condition. The good news is that the vast majority of conditions that can cause rectal bleeding are entirely benign and do not offer any concern.

The commonest type of rectal bleeding often occurs when we go to the toilet. This is often either on the paper or occasionally it can be on the faeces or even in the pan. Regular occurrences of rectal bleeding is not normally associated with anything sinister however it does need to be checked out to be on the safe side.

It is often rectal bleeding nothing is commonly associated with having constipation straining or even occasionally over wiping due to concerns about hygiene.

If you’re under the age of 50 and you just get the odd occasional bit of spotting on the paper after you have gone to the toilet which only lasts one to 2 days and there’s normally just associated with wiping then this can often be attributed to just simply over straining.

However, should you have any of the following, it’s quite possible this could be attributed to haemorrhoids, in which case it would be worth seeking some advice:

  • Ongoing rectal bleeding that last more than three or four days
  • Bleeding that progressively gets worse
  • Blood more frequently being on the paper that is more than a few spots or on the faeces or going into the pan

Often painless rectal bleeding is generally associated with haemorrhoids and over straining.

Frequently asked questions – rectal bleeding

How much bleeding is normal?

Probably the most frequently asked questions are about ‘how much bleeding is a concern’.

The answer is, if it is generally only for a few days and is only associated with a small amount of blood on the paper on wiping and this can also be attributed to just over straining or some local irritation. If the blood is more than soaking the tissue paper when you wipe all is into the pan and causing discolouration of the water and it be advisable to see your doctor.

If there’s no pain, does it mean I’m OK?

It’s common to not get pain when you occasionally get some bleeding. This situation is often caused by haemorrhoids. Piles can go up-and-down and swell according to your diet and bowel habit in terms of straining, so these areas should be addressed to see if your symptoms improve.

What if I get pain and bleeding at the same time?

If you experience a sharp pain as well as bleeding upon opening your bowels then this can be commonly attributed to a fissure or a small tear in the anal canal

If I get pain and bleeding at the same time how long should it reasonably take to settle?

Occasionally people can be constipated or have diarrhoea or overstrain when opening their bowels and this can lead to a small tear. In most cases this should settle down over a week to 10 days. During this time you can experience a sharp pain and some bleeding which only last during the period that you are on the toilet. Should however it pissed persist beyond this then it would be worth consulting a doctor.

What causes rectal bleeding?

The commonest causes for rectal bleeding are haemorrhoids anal fissures/tears, local trauma or skin irritation. Other potential causes include bowel conditions such as ulcerative colitis or Crohn’s disease and other potentially more sinister things such as colon cancer or anal cancer

What tests are involved to investigate rectal bleeding?

The commonest investigation to look for a cause of rectal bleeding is what’s known as a proctoscopy. This is a small scope that is placed inside the anal canal to check for local causes should there be no obvious cause for that then a procedure called a colonoscopy which is where a small fibre telescope is put into the anal canal that travels further up into the Barrell area to check for any other courses that may be higher up

Are there any non-invasive ways to check for causes of rectal bleeding?

There are specific tests called faecal occult bloods which test your stools for the presence of blood and these can be used as a screening tool for colon pathology

Are there different types of rectal bleeding?

Yes, often fry fresh bright red blood is associated with lower end of rectal bleeding so normally around the anorectal areas however a key and this is often then on the surface or mixed in with the faeces and is often easily visible.

However bleeding higher up in the gastrointestinal tract such as the stomach can often cause the stools to turn black and this can often sometimes be associated with indigestion symptoms or upper abdominal pain this black stool is called Melina. This is a surgical emergency in which case you would be advised to contact your doctor immediately

Rectal bleeding check list

No action / observe

  • A few drops or spots on paper that lasts only few days with or without pain and is associated with straining on bowls opening or altered bowl habit i.e. constipation due to alcohol , steak meal etc
  • No action unless continues


  • Soaked tissue paper or blood in the toilet pan or on stools
  • Pain and bleeding on bowls opening lasting over 10 days
  • Dark black stools (melaena) urgent action

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