What is rectal bleeding?

Rectal bleeding means bleeding from your back passage (anus) when you go to the toilet and pass faeces (poo).

When should I go to the emergency department?

You should always have bleeding from the anus checked out by a doctor as it could be a sign of something serious.

Seek urgent medical attention if:

• the bleeding is very heavy
• you have signs of shock like rapid, shallow breathing, dizziness, nausea or confusion
• you have black or dark red poos
• your vomit contains blood or what looks like coffee grounds
• you faint
• you have a severe pain in your rectum
• you have heavy rectal bleeding along with bad stomach pains, a fever, weakness, nausea or you cannot have a bowel motion (poo)

What are the symptoms of rectal bleeding?

The colour of your blood can indicate where in the gastrointestinal system the bleeding is coming from. For example, fresh, bright red blood can show the bleeding is coming from lower in the bowel, nearer to the back passage, which may be a sign of haemorrhoids or fissures.

Bleeding in your large intestine (colon) may be fresh red or a darker red and mixed in with your faeces. One of the causes can be polyps, which are growths on the intestinal wall. Polyps are usually harmless, but some types can turn into bowel cancer.

Faeces that are black, like tar, and that have a very bad smell may suggest a problem higher up in the gastrointestinal system — for example, in the stomach or duodenum — such as a bleeding ulcer.

What causes rectal bleeding?

There are lots of possible causes for rectal bleeding. Common causes include:

• hard stools (poo)
• haemorrhoids (also known as piles), which are often associated with constipation
• anal fissure (a small tear in the opening of the anus) or fistula (a small channel that develops between the anus and skin)

Less common causes include:

• colon polyps
• rectal trauma (for example, an injury caused by accident or sexual assault)
• stomach or duodenal ulcers
• infections of the bowel
• gastroenteritis
• bowel conditions, such as diverticular disease or bowel cancer, Crohn’s disease or ulcerative colitis
• sexually transmitted infections

When should I see a doctor?

Make an appointment to see your doctor if you have rectal bleeding that lasts more than 1 or 2 days, or earlier if the bleeding worries you.

Most people who have rectal bleeding don't have cancer or another serious illness, but it's important to have it checked out.

How is rectal bleeding diagnosed?

The tests for rectal bleeding depend on your age, symptoms and medical history. Your doctor will talk to you and examine you, and might want to look inside your rectum and bowel. You might also need tests, including:

• Anoscopy — this is when a small instrument is inserted into your anus to allow your doctor to have a clearer view.
• Sigmoidoscopy — this is a procedure to look inside of the left, lower part of your colon (large bowel) using a flexible telescope.
• Colonoscopy — a flexible tube is inserted into the anus to view the inside of the large bowel (the colon).

Some of these tests are done under sedation and anaesthetic. Ask your doctor for more information.

How is rectal bleeding treated?

Treatment will depend on what is causing the rectal bleeding.

For some problems, the treatment could be to make changes to your lifestyle or diet.

Haemorrhoids often settle down quickly after a few days and do not require any special treatment. If your haemorrhoids are causing you pain or discomfort, ask your doctor or chemist about medicated creams or ointments that may ease your symptoms.

If your haemorrhoids keep coming back, you can talk to your doctor about the possibility of surgical treatment.

Treatment for anal fissures can involve botox injections or surgery.

Can I manage or prevent rectal bleeding?

If you have rectal bleeding, there are a number of things you can do to help manage the condition.

If you have constipation causing haemorrhoids, you can help ease it by:

• drinking plenty of water, unless you have an existing medical condition that means this is not possible
• eating fibre-rich foods, such as bran cereals, fruit, vegetables and wholegrain bread
• avoiding processed foods, such as white bread and cheese
• keeping active and mobile to reduce the risk of getting constipated
• going to the toilet when you have the urge

If your doctor has confirmed that you have an anal fissure, you can ease the discomfort by:

• very carefully wiping the anal area after going to the toilet and using soft, moist toilet paper or baby wipes, rather than dry toilet paper
• patting the area around your bottom rather than rubbing it
• having warm baths a few times a day
• seeing your pharmacist for topical creams to reduce the pain
• making sure you eat a healthy diet with plenty of fibre, and drinking plenty of fluids to keep your stool as soft and well-formed as possible
• trying not to strain when passing a stool

Do not apply creams and lotions to the area that were not prescribed by your doctor or pharmacist because this can cause more trauma.

Suspicion of deliberate harm

If there is any suspicion that rectal bleeding is not the result of an anal condition but is due to an injury inflicted on purpose, you should seek help from a healthcare professional as soon as possible. This could be from a nurse or doctor at a hospital emergency department, or a doctor’s surgery, or a health visitor or school nurse.