In this article, we’ll go over the reasons you might experience rectal bleeding, how to spot the symptoms, how doctors diagnose the cause, and what treatments are available.
What Is Rectal Bleeding?
Simply put, rectal bleeding means that there is blood coming from your lower digestive tract, either from your anus or from within the rectum. You might see this blood in your stool, on toilet paper, or even in the toilet bowl. The color of the blood can vary—bright red, dark red, or even black, depending on the source and how long the blood has been in the digestive tract.
Common Causes of Rectal Bleeding
There are several reasons why rectal bleeding might occur. Some are minor, while others might be more serious. Here are some of the most common causes:
1. Hemorrhoids
Hemorrhoids are swollen blood vessels in the rectum or anus, and they’re the most frequent cause of rectal bleeding. They’re often the result of straining during bowel movements, constipation, or even pregnancy.
Signs to Look For:
- Bright red blood on the toilet paper or in the toilet bowl.
- Itching, irritation, or a feeling of fullness around the anus.
- Discomfort when sitting or during bowel movements.
2. Anal Fissures
These are small tears or cracks in the skin around the anus, which can be painful. They often occur from passing hard stools or from straining.
Signs to Look For:
- Sharp, intense pain during or after a bowel movement.
- Bright red blood on the stool or toilet paper.
- Itching or irritation in the area.
3. Diverticular Disease
Diverticulosis happens when small pouches (called diverticula) form in the walls of the colon. If these pouches become inflamed or infected, it’s called diverticulitis, which can cause rectal bleeding.
Signs to Look For:
- Sudden rectal bleeding.
- Abdominal pain, especially in the lower left side.
- Fever or chills (in cases of diverticulitis).
4. Colorectal Polyps
Polyps are growths on the inner lining of the colon or rectum. While most polyps are harmless, some can develop into cancer over time. Polyps often don't cause symptoms, but they can occasionally lead to bleeding.
Signs to Look For:
- Occasional, unexplained blood in the stool.
- Abdominal discomfort or bloating.
- Changes in bowel habits (constipation or diarrhea).
5. Colorectal Cancer
Unfortunately, colorectal cancer is another possible cause of rectal bleeding, especially in people over 50 or those with a family history of the disease. The bleeding can sometimes be hidden, making it difficult to notice without screening.
Signs to Look For:
- Unexplained weight loss.
- Fatigue or weakness.
- Persistent changes in bowel movements, such as diarrhea or constipation.
- Dark or tarry stool (which could indicate bleeding higher up in the GI tract).
6. Inflammatory Bowel Diseases (IBD)
Conditions like Crohn’s disease or ulcerative colitis, which cause chronic inflammation in the digestive tract, can lead to rectal bleeding. These diseases can also cause ulcers or sores that bleed.
Signs to Look For:
- Bloody diarrhea.
- Abdominal cramping or pain.
- Fatigue and weight loss.
7. Other Causes
In some cases, rectal bleeding may be due to other less common causes, such as infections, ulcers, or a tear in the gastrointestinal lining (like a Mallory-Weiss tear). These are typically associated with more severe pain and symptoms.
When to See a Doctor
If you notice blood in your stool, it’s important to pay attention to how much blood is there and how often it happens. In some cases, a small amount of blood due to hemorrhoids or an anal fissure might not require immediate medical attention. However, you should definitely consult a healthcare provider if:
- You notice a lot of blood (e.g., a pool of blood in the toilet or excessive blood on toilet paper).
- The blood is dark or black (this could indicate a problem higher up in the digestive tract).
- You have ongoing pain, cramps, or discomfort.
- You experience unexplained weight loss or fatigue.
How Is Rectal Bleeding Diagnosed?
To determine the cause of rectal bleeding, your doctor may ask about your medical history, any other symptoms, and the nature of the bleeding. They might also recommend the following tests:
1. Physical Exam
Your doctor might perform a physical exam, which could include a digital rectal exam (DRE), where they gently insert a gloved finger into your rectum to check for hemorrhoids, fissures, or other abnormalities.
2. Stool Tests
In some cases, your doctor may ask you to provide a stool sample to check for hidden blood, infections, or other markers that could point to a specific cause.
3. Colonoscopy or Sigmoidoscopy
If your doctor suspects a more serious cause like polyps, cancer, or IBD, they might recommend a colonoscopy (a long tube with a camera inserted into the rectum to examine the colon) or sigmoidoscopy (a similar test that examines only the lower part of the colon).
4. Imaging Tests
In certain situations, your doctor might order imaging tests such as a CT scan or MRI to look more closely at your colon or other parts of your digestive tract.
Treatment Options for Rectal Bleeding
How your rectal bleeding is treated will depend on the cause. Here’s an overview of treatments for common conditions:
1. Hemorrhoids
Treatment often starts with lifestyle changes, such as eating more fiber, drinking plenty of water, and avoiding straining during bowel movements. Over-the-counter creams and ointments can help ease pain and itching. In some cases, procedures like rubber band ligation (a simple office procedure) or surgery may be needed.
2. Anal Fissures
To help the fissure heal, your doctor may recommend stool softeners, pain-relieving creams, or topical treatments to promote healing. If the fissure is severe or chronic, surgery may be necessary.
3. Diverticular Disease
If you have diverticulitis, antibiotics are often prescribed to treat the infection. In more severe cases, surgery might be required to remove the affected part of the colon.
4. Colorectal Polyps or Cancer
Polyps are typically removed during a colonoscopy, reducing the risk of them becoming cancerous. If you have colorectal cancer, treatment options might include surgery, chemotherapy, or radiation therapy, depending on the stage of the disease.
5. Inflammatory Bowel Disease
IBD is usually managed with medications to reduce inflammation and suppress the immune response. In some cases, surgery may be necessary if medication doesn’t work.
Can Rectal Bleeding Be Prevented?
While some causes of rectal bleeding can’t be prevented, there are a few things you can do to reduce your risk:
- Eat a fiber-rich diet to prevent constipation and straining.
- Stay hydrated by drinking plenty of water.
- Exercise regularly to keep your digestive system working well.
- Get screened for colon cancer starting at age 45 or earlier if you have risk factors.
Conclusion
While rectal bleeding can be concerning, it’s often caused by conditions that are treatable, like hemorrhoids or anal fissures. However, it’s crucial to pay attention to the symptoms, get checked by a healthcare provider, and follow their advice for managing or treating the underlying issue. If you experience ongoing bleeding or other worrisome symptoms, don’t hesitate to seek medical care to ensure the right treatment.