Is it serious?
You’re going to the bathroom and when you finish, you notice that there is blood on the toilet paper. It isn’t a large amount and its bright red in color. Should you be concerned? Do you need to go to the doctor?
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Definition
Rectal bleeding is any blood that passes from the anus regardless of the source. Typically, the bleeding is from your lower colon, rectum (last few inches of your large intestines) or anus. The blood can range from bright red to dark maroon. Usually, the brighter the color, the closer the bleeding is to the anus. Darker colored blood means that the blood has had time to collect together and begins clotting. The amount of blood can vary from small (just a little on the toilet paper) to large (filling the toilet bowl). The most common reasons that you have rectal bleeding are anal fissures (small tears in the tissue of the anus) and hemorrhoids (swollen veins in the anus or lower part of the rectum that open)—both of these are caused by chronic constipation and the need to pass hard stools. Some other causes of rectal bleeding are cancer (anal, rectal, colon), angiodysplasia (abnormal blood vessels near intestines), colon polyps, Crohn’s disease, diverticulosis, colitis (inflammation of colon from ischemia—reduced blood flow, pseudomembranous—infection, or ulcerative—ulcer), proctitis (inflammation of the rectum) and radiation therapy.
Treatment
Treatment depends on the cause. In most cases, the rectal bleeding will stop on its own. This is true for small hemorrhoids and anal fissures, where you have a small amount of bright red blood on toilet paper when you wipe. You should talk to your doctor about fixing these before they become worse. This can include removing the clotted blood from hemorrhoids, if large enough, and stitching closed any fissures. If you have any rectal bleeding that lasts more than a day or two, you should see your doctor. If your rectal bleeding is continuous (every time you go to the bathroom), a large amount (the toilet bowl is covered in blood or you are passing clots) or you are having severe abdominal pain/cramping with it, you should have someone drive you to the nearest emergency room. If you are having rectal bleeding and signs of shock (rapid/shallow breathing, dizziness/lightheadedness after standing up, blurred vision, fainting, confusion, nausea/vomiting, cold/clammy/pale skin and/or low urine output), you need to call 911.
Prevention
For the most common reasons of rectal bleeding (hemorrhoids and anal fissures), prevention is key. In order to prevent either of these from occurring, it is vital to prevent constipation and passing hard stools. You can do this by increasing your fiber intake to help increase the frequency of your bowel movements. If needed after consulting with your doctor, you can take medication to help soften your stool. Exercise is a great way to regulate bowel function—those who exercise usually have more frequent bowel movements. For other types, it is important to monitor your condition and follow any prescribed treatment plan.
Rectal bleeding can come as a shock, especially if it is a large amount. By doing what you can to prevent it, you will decrease your chances of having it happen to you. If you have any questions, please consult with your doctor. If you would like more information, please visit American Society for Gastrointestinal Endoscopy’s rectal bleeding page at https://www.asge.org/list-pages/patient-informations/understanding-minor-rectal-bleeding