Rectal Bleeding: What a Doctor Wants You to Know

The solution is often simple, and up to you

toilet paper

The first thing most people worry about when they have minor rectal bleeding is that they have a cancer. Of course, colon cancer is what I worry most about, too. But it’s the cause of rectal bleeding only 1 to 2 percent of the time.

Two problems are usually responsible for blood on the paper, on the stool or in the toilet: hemorrhoids and anal fissures. The good news is that both problems are usually easy to fix.

Age and family history matter

If you’re older than 30 or have a family history of colon cancer, the first step is a colonoscopy. Colonoscopy is easy, usually painless, and rules out cancer so you don’t have to worry. If we find a polyp that is causing the bleeding, we can remove it before a cancer ever develops.

If you’re under 30, have no family history of colon cancer, and the source of pain and bleeding is obvious, then I usually won’t suggest colonoscopy right away because:

  • When a hard stool causes pain and bleeding, it’s usually an anal fissure, or tear in the tissue. Chronic constipation, prolonged diarrhea, straining and anal intercourse can all cause anal fissures.
  • When rectal bleeding is painless and develops after heavy lifting, a long car trip, pregnancy or constipation, it usually means internal hemorrhoids. Anything that places continual pressure on veins in the anus can engorge them. Over time, they can get bigger and bigger. Then when you get a hard stool, it scrapes them and they bleed.

A note about hemorrhoids: They’re our friends, but they get a bad rap. These are natural veins that enlarge, becoming cushions of soft tissue that line our butt muscles (the sphincters). This creates a stronger seal so gas won’t escape when we walk. Hemorrhoids also help continence up to 30 percent.

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Two problems, one solution

Using Metamucil® (the powdered form) and drinking lots of water will clear up most anal fissures and hemorrhoids. Metamucil bulks up, or softens, the stool, and drinking water moves the stool through faster. Then you just sit on the toilet and go — there’s no strain. When stool comes out easily, bleeding is less likely.

The best part about Metamucil is that it helps with diarrhea-related issues as well. So you can take it if your stools are hard or loose.

If bleeding continues despite using fiber and water — or if you can’t think of any cause for the bleeding — then you need to see a doctor. An evaluation and colonoscopy exam will rule out polyps, cancer, inflammatory bowel disease (IBD) or other problems that require treatment.

Surgical options

Colorectal surgeons have different surgical options to treat hemorrhoids:

  • One is to choke the veins with rubber bands, called hemorrhoid banding. We do this in the office, without anesthesia.
  • We can also use staples or sutures to tie off the veins in an outpatient procedure.

These procedures are pretty painless and work well for internal hemorrhoids.

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Over-the-counter remedies

If you have hemorrhoids inside, you often have them outside too. Internal hemorrhoids bleed and are painless. External hemorrhoids swell, hurt and can itch.

Over-the-counter preparations stop hemorrhoid pain and ease swelling. Some people use them for internal hemorrhoids, but they rarely stop bleeding. While these products are very safe, try not to use them long-term because they contain witch hazel and can cause itching.

A change of habits will do you good

Once you feel better, remember that it’s important to change your bowel habits. Hemorrhoids and fissures will return even if you’ve had surgery unless you fix the habits — like constipation and straining — that caused them.

Many people who come to see me are reluctant to try Metamucil and water for their hemorrhoids or fissures. But the majority of those who try this are shocked by how well it works.


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Meagan Costedio, MD

Meagan Costedio, MD, is a surgeon in the Department of Colorectal Surgery whose interests include minimally invasive techniques.
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  • c lees

    I’ve had 2 rectal fissures removed a few years apart and in different areas of rectum. Should I be worried.

  • Annie J

    I think this is one of the best articles I have ever read concerning this subject. One thing you didn’t address though, is medication as a cause of constipation. No amount of Metamucil has helped in that regard. This is medication that I have to take, so what advice is there for that situation?

  • Dianne jones

    I had silent bleeding. I was feeling awful for about a year. I went to donate blood. They tested me. My HGb was 5.5. I saw my MD. Had fissures in colon. Surgery stopped the bleed

  • weez

    I was taking low dose aspirin to lower colesterol It caused rectal Bleeding! I passed out in the bathtub, ended up
    In the Hospital.. I stopped the aspirin and the bleeding stopped!

    • Abdominal Pain

      Bleeding from WHERE? I blamed low-dose aspirin for bleeding which was actually coming from a POLYP, which could have been removed before it turned cancerous, but wasn’t. I too stopped the aspirin and the bleeding stopped. Then it started again…

      (Re-posted without the link.)

  • Bibi

    Metamucil is full of artificial ingredients. Organic Psyllium husks are much healthier.

  • Ghyail Williams

    I now use metamucil, very happy with the results.

  • Karen Jones

    A good friend of mine is bleeding from somewhere indide and the Doctor’s cant find out where.He has had all the test done twice are more and still they cant seem to find where its comming from.Please what could this be?

  • Emily

    I have a what seems like a hemorrhoid and it itches, but I don’t use the flushable wipes, do you know what it could be and why it itches ?

  • Echo

    I had a terrible experience with diverticulosis and ended up in the ER for 4 hours and finally the pain subsided and I went home with no further treatment. They hadn’t seen me in four hours but then suddenly said I shouldn’t leave because it could have been kidney stones. Three days later I was scheduled for an MRI to determine if I had diverticulosis — and I do !!! I had been eating lots of nuts and seeds prior to the onset of the severe pain. I don’t eat them now and the pain is GONE! Occasionally, I believe I feel a “soft” pain probably from “gas” if I eat too many cruciferous veggies such as broccoli or cauliflower. My BEST remedy for the pain is a heating pad applied to the painful area — most articles say it’s on the LEFT side — mine is on the right — and I drink a double-strength cup of hot chamomile tea which also works 100% of the time when you have trapped gas. It works generally in 20 minutes.
    Maybe this all sounds crazy to you, but I learned of the chamomile trick years ago from an older woman in my office. I tried it and swear by it. Awesome.
    Also, I STILL believe in staying away from the nuts, seeds, popcorn, corn, etc. that in the past they said irritated the pockets in the colon. The pain it caused me that put me in the ER that day is not worth eating stuff like that again. I miss them, but I’m not a glutton for pain either. One or the other. Best wishes.

    • terryparker

      i also just found my right side was in so much pain and it felt like the first hard labor pains . i woke up to this i believe my was brought on by strawberries and hornoll less popcorn. ty you for sharing i am trying to ;learn much more about this condition.

      • Echo

        And thank you for verifying that it CAN be on the RIGHT side. My doctor and all the accounts I’ve read have indicated on the LEFT side. On the other hand, the doctor said it is rare on the right side. Leave it to me (and now you!!!) to be different!!! I don’t mind being different, but when it strikes, it’s vicious. I’m sure I don’t have to tell you — labor pains is right. Just unbelievable. The thing that’s amazing to me is that it stops you in your tracks from eating things that are supposed to be good for you — nuts, seeds, and some fruits because of their seeds. Don’t forget, tomatoes, cucumbers, zucchini and squash, too! And DEFINITELY NO CORN OR POPCORN!!! You will die a slow death if you eat them — or you’ll think you’re dying . . . I’m sorry we share the same malady. Do take care and watch other things like salad dressings with seeds, etc.
        A LOT of label/ingredient reading . . . ;(

      • Echo

        One more thing — actually a couple more things — don’t overdo on the cruciferous veggies such as cauliflower and broccoli and perhaps spinach — anything that may cause gas. Fiber is good for you, but watch that, too, as it may cause gas if eaten in large amounts. BUT, if you should get those awful pains — and this is for EVERYONE — keep CHAMOMILE TEA on hand AT ALL TIMES . . . Many years ago an older woman told me about it and how it relieves that “bloated feeling”. Just brew up a cup, let it steep about 6 minutes and drink as much as you can while it’s still hot. Give it about 10-15 minutes to work. You may have to go to the bathroom, burp or pass gas, but it won’t last long but the results are worth it. Not a savory subject to discuss, but saves hours of pain.

  • radcont5164

    Wrong!!! A colonoscopy is nothing but a cash cow for the medical industry and usually doesn’t prove anything. Many doctors in other countries have stopped giving them because they can be dangerous if not done properly, or can cause other problems.

  • Mark

    Hi I’m really scared because when I go number 2 it hurts a little bit and when I wipe there is blood not a lot but there is some. I’ve never had this pain before.