What To Do if You Have Rectal Bleeding (With or Without Pain)

Whenever you discover you’re bleeding, it gets your attention. It’s usually easy to find the source of the blood, but when it’s coming from your rectum, the origin isn’t as easy to pinpoint. That’s enough to make anyone worry. So, what are the most likely sources of rectal bleeding?

Colorectal surgeon Massarat Zutshi, MD, discusses likely causes of rectal bleeding and what your next steps should be if it happens to you.

What’s causing your rectal bleeding?

Rectal bleeding can happen for many reasons, the vast majority of which are benign. The following steps will help you determine if you need to be in contact with a doctor.

Your first task: Determine if you’re actually bleeding.

Before worrying too much about what you’re seeing in the toilet or on your toilet paper, think carefully about what you’ve consumed in the recent past. There are several foods and medications that can alter the color of your stool.

• Beets, cranberries, tomatoes and products that use red food coloring — especially Red Dye 40 — can dye your stool red.
• Blueberries, black licorice and medications that contain bismuth — like Pepto Bismol® or Kaopectate® — can turn your stool black.

If you’ve established that you are bleeding, your next step is determining the blood’s origin point. That will help you figure out if you need to seek medical attention.

What color is the blood?

Blood color is one way to narrow down the possible causes of your rectal bleeding. Think of the blood color as indicative of travel time. It takes longer for blood from your esophagus to pass through your body than blood from an anal fissure. During that time, the color and consistency of the blood change. The redder the blood, the closer to your anus the origin point will be. In other words:

• Bright red blood originates from your lower GI tract — think lower colon, rectum or anus.
• Dark red or maroon blood originates higher up — think upper colon or somewhere in your small intestine.
• Dark, tar-colored blood could originate as far up as your esophagus

Common causes of rectal bleeding

1. Hemorrhoids. It’s normal for everyone to have hemorrhoids inside and outside of their anus, and there are several reasons they may become irritated. If you notice blood on your toilet tissue or in the toilet, the factors that may point to hemorrhoids include:
   • Constipation.
   • Diarrhea.
   • Low-fiber diet.
   • Heavy lifting.
   • Hard stools.
2. Anal fissures. If there are tears in the tissue of your anus, then you may experience both rectal bleeding and pain during and after a bowel movement. Typical causes of anal fissures include:
   • Chronic constipation.
   • Diarrhea.
   • Straining.
   • Anal intercourse.
3. Diverticulosis and diverticulitis. When tiny pockets, or diverticula, form in the lining of your bowel, you have diverticulosis. Pressure on weak spots in your intestinal wall may cause these tiny pockets to form. Diverticulitis occurs when your diverticula become infected and swollen.
4. Peptic ulcers. A peptic ulcer occurs when gastric acid eats away at the protective walls of your stomach. The resulting sores frequently bleed.
5. Inflammatory bowel diseases. Conditions like ulcerative colitis and Crohn’s disease inflame your intestines. Blood loss can be mild, but it can also be significant enough to cause anemia.
6. Colon cancer. In a very small number of cases, rectal bleeding is a sign of colon cancer. You may also notice other symptoms, such as unexplained weight loss or pain in your abdomen.

Colon cancer typically starts with polyps in your colon. Early detection is the goal here, Dr. Zutshi says. Polyps are typically benign at first, and a surgeon can remove them before they become cancerous if you catch the problem early.

Dr. Zutshi emphasizes that hemorrhoids and anal fissures are responsible for rectal bleeding about 98% of the time. But it’s important to let your doctor know if you experience rectal bleeding so they can rule out any other problems.

Painful rectal bleeding

Painful rectal bleeding, while certainly unpleasant, isn’t always a sign that something’s seriously wrong. A lot depends on the severity of the pain and where you’re feeling it. Hemorrhoids and anal fissures can hurt. In most cases, though, they either spontaneously resolve themselves or are easily treated by a doctor. Pain or cramping in your abdomen is a different story. If you’re in significant pain, regardless of the cause, you should speak with a doctor.

Rectal bleeding with no pain

It may be preferable, but painless rectal bleeding isn’t necessarily less severe than painful rectal bleeding. Hemorrhoids aren’t always painful, but the same is true of colorectal cancer. Not being in pain isn’t a reason to skip a trip to the doctor, especially if you have other symptoms, like changes to your stool or nausea.

How to manage bleeding at home

If you’re fairly certain that the bleeding is the result of hemorrhoids or an anal fissure, you don’t need to run to the doctor. These are common problems, and you can treat them yourself at home.

• Use an over-the-counter medication. There are lots of hemorrhoid creams, ointments and suppositories available at your local drugstore. Don’t use steroid creams.
• Use medicated wipes. Witch hazel-soaked pads work as an astringent, cleaning your anus and reducing itching and irritation.
• Use an ice pack for pain relief. If the idea of grabbing an ice pack from your freezer squicks you out, you’re not alone. Luckily, there are ice wedges designed for hemorrhoid care that — like perineal ice packs — come with washable sleeves.
• Take a sitz bath. If you’re struggling with pain, burning or itching, it’s time to get in the tub. This shallow-warm water bath will increase blood flow to your anal tissues, which will facilitate pain relief and healing.
• Bathe daily. If you’re struggling with hemorrhoids or fissures, it’s important to keep the skin around your anus clean. Remember to steer clear of harsh soaps that could irritate the area further.

There are also things you can do every day to prevent hemorrhoids and anal fissures.

• Stay hydrated. That means drinking eight to 10 8-ounce glasses of water a day. It also means limiting your alcohol and caffeine intake.
• Avoid straining and sitting on the toilet too long. It puts pressure on the veins in your rectum and anus, which can cause new hemorrhoids to form — or exacerbate the ones you already have.
• Increase your fiber intake. Constipation and hard stools can cause hemorrhoids and anal fissures. A high-fiber diet will soften your stool, which, in turn, keeps you from straining.

If these home remedies aren’t alleviating your symptoms, or you’re continuing to bleed, it’s time to get medical attention.

When to see a doctor

Because rectal bleeding has so many causes — some routine, others rare — it’s important to pay close attention to the kind, severity and duration of the symptoms you’re experiencing. Those factors determine the type of medical attention you need and the urgency with which you need it.

• Schedule a visit with a doctor if the bleeding lasts more than one to two days or if symptoms haven’t improved after trying home remedies for a week.
• Get immediate medical attention if the bleeding is continuous or heavy, or if you’re experiencing the following symptoms:
  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Abdominal pain or cramping.
  • Narrow stools or a change in the quality or frequency of your stools.
• Call 911 if you’ve lost more than two pints of blood, you sustained severe rectal trauma like a puncture wound or you’re experiencing the following symptoms of shock:
  • Rapid, shallow or difficult breathing.
  • Dizziness or blurred vision.
  • Lightheadedness or fainting.
  • Confusion.

Remember, no matter where it’s coming from, blood loss exceeding two pints is a serious medical emergency. Losing more than 4.2 pints of blood is potentially deadly. If your bleeding is that severe, you need an ambulance.

What your doctor needs to know

It’s helpful if you can make a note of how long you’ve been experiencing rectal bleeding, if it stops then starts again and how long it lasts.

Your doctor will likely ask you:

• Do you see the blood in the stool and/or in the toilet bowl?
• What color is the blood?
• Does the blood always show up with a bowel movement?
• What other symptoms (if any) are you experiencing?
• Are you in pain?
• What is your family medical history?

Plan to start screenings after age 45

Even if you aren’t experiencing problems or noticing any rectal bleeding, Dr. Zutshi emphasizes that it’s vital to begin having colon cancer screenings when you turn 45. She adds that you should start having regular screenings earlier if you have any history of colon cancer in your family. Whenever possible, you should start getting colonoscopies 10 years before the age at which your relative received their cancer diagnosis).

Don’t be shy

It’s not unusual to be squeamish about butts and guts, but neither is it unusual to have problems with them. Rectal bleeding is a common medical issue that’s usually innocuous. When in doubt, though, swallow your pride and talk to a doctor. It’s better to be safe than sorry.