There are a lot of colors, usually shades of brown, we are accustomed to seeing when we are done going to the restroom. But what happens if you get up from the toilet and see bright red streaks of blood on the toilet paper, in your feces, or in the water in the toilet bowl? Should this be a cause for alarm? What might be wrong with you?

Since your gastrointestinal system is (normally) a one-way street, anything that goes wrong from your esophagus on down will eventually show up in your poop. This means the causes, seriousness, and treatment of rectal bleeding are numerous. 

What Does Rectal Bleeding Mean?

Unlike some other medical issues with confusing names, rectal bleeding is what it sounds like: blood issuing from your rectum. It is possible the source of the bleeding is at the anus itself in the form of hemorrhoids, or it could be coming from higher up in your digestive tract. In fact, prolonged, constant vomiting can even cause blood to show up on toilet paper or in your stool. 

Minor rectal bleeding can be nothing more than irritation of the area around the anus, or it could be evidence of life-threatening illnesses like cancer. A little blood on your toilet paper that goes away soon is probably nothing to worry about. On the other hand, if your bleeding continues, worsens, or is accompanied by other symptoms like abdominal pain, fainting, nausea, or other symptoms, you should seek medical treatment immediately. 

What Causes Rectal Bleeding?

Many things can cause rectal bleeding. Anal fissures, or small tears in the lining of the anus from passing hard stool, are a common cause, as are hemorrhoids. Hemorrhoids are caused by swollen, irritated, or ruptured veins in the end of your rectum or around your anus. These weakened blood vessels are one example of a cause of rectal bleeding that is not dangerous, though people who suffer from the irritation and pain of hemorrhoids will definitely tell you hemorrhoids are no laughing matter.

There are other common causes of gastrointestinal bleeding that come from weakened blood vessels further upstream in your intestines. Angiodysplasia is a condition where the blood vessels in the lining of the colon become fragile over time. This condition is more common with the elderly, and typically appears slowly.

Further up the digestive tract, issues with your esophagus, stomach, and small intestine can all possibly contribute to rectal bleeding. These sources of blood may not be as obvious to spot, as the blood has time to mix with your stool before it reaches the anus. In these cases, it is sometimes likely you will see maroon or black tarry stool rather than bright red blood. This kind of bleeding can come from damage to the esophagus or the lining of the stomach. 

Diverticulitis is another digestive disease that is relatively common, especially in older Americans. Diverticula are pouches in the side of the intestine that form in places where the wall of the intestine has become weakened. These pouches often form in people who eat a low fiber diet. Food can become trapped in these pouches, leading to inflammation, infection, and sometimes bleeding. 

Colon polyps are another source of blood that ends up in your stool. Unlike diverticula that create pockets in the intestinal wall, polyps are bulges of tissue that protrude into the intestinal tract. Bleeding can occur as these polyps form, but these lumps are typically not dangerous or harmful. Some colon polyps can be a cause of concern, though, as certain types of these growths can be precancerous. 

Another cause of rectal bleeding is a set of digestive diseases such as Crohn's disease. This condition, which is believed to be an autoimmune disease, is one of the major conditions lumped in under the term Inflammatory Bowel Disease (IBD). For people with Crohn's disease, inflammation, and irritation in the wall of the intestine causes a range of unpleasant or dangerous symptoms. Diarrhea, fatigue, and weight loss are all possible, as your intestines are unable to absorb nutrition properly when they are inflammed. This condition can lead to blood seeping into the intestine from irritated tissue, thus leading to blood in the stool. 

Blood in your stool could be caused by something relatively harmless, but at the serious end of the spectrum lies the specter of cancer. There are a few different types of cancer that could result in blood in your stool. Colon cancer and anal cancer are two of the most well known, though they are not the only varieties. Both of these forms of cancer can be deadly, especially when they are not caught until cancer has progressed to an advanced stage.  

When Should I Seek Medical Help? 

The decision on when to seek medical advice for rectal bleeding will depend on how severe your bleeding is, and whether you are experiencing other symptoms. As mentioned above, if you don't have any other symptoms, a little blood showing on your toilet paper for just a few bowel movements may indicate nothing more than hemorrhoids or small anal fissures. These conditions can heal on their own, or be treated with conservative home remedies and over-the-counter treatments aimed at reducing the severity of symptoms.  

Long-lasting bleeding is a cause for concern. The volume of blood in your stool is also an indicator of how severe problems may be. If you suddenly see a large amount of blood in the toilet, or if the amount of blood you have seen increases rapidly, seek medical treatment as soon as possible. 

The real concern with rectal bleeding comes when your bleeding occurs alongside other concerning symptoms. If you are having any of the following in conjunction with blood appearing in your stool, seek medical treatment immediately:

  • Severe fatigue
  • Nausea
  • Unexplained weight loss
  • Abdominal pain
  • Swelling in the abdomen
  • Low blood pressure
  • Confusion
  • Rapid heart rate
  • Dizziness
  • Vomiting
  • A distinct change in bowel habit

Blood loss, especially from internal bleeding, can be a danger in its own right, especially for the elderly. It can also be a sign of other issues such as intestinal trauma. If something has caused a hole to develop in your intestines, you are at high risk for fast moving and potentially deadly infection and must seek medical treatment immediately. 

How is Rectal Bleeding Diagnosed?

The presence of blood in your stool is not hard to identify. Sorting out just where it is coming from inside you can be more difficult. There are a number of diagnostic options your doctor will have if the bleeding is coming from the area immediately around the anus. If your bleeding is originating further inside your digestive tract, though, your doctor will need to find a way to take a look inside. 

There are several procedures for looking inside your gastrointestinal tract, and not surprisingly many of them are variations on the same theme. Upper endoscopy, sigmoidoscopy, and colonoscopy are all terms for different types of a procedure where a small tube is inserted into either the mouth (in the case of an upper endoscopy) or the anus. This flexible tube has a tiny camera and light at the end to allow your doctor to see what is going on inside your GI tract. In some cases, tissue samples can also be retrieved for further analysis. This is commonly done if cancer is suspected and tissue samples are needed for biopsy. 

The images and tissue samples gathered during a colonoscopy or sigmoidoscopy are typically what your doctor will use in diagnosing the cause and severity of your rectal bleeding. Other diagnostic procedures can sometimes be needed, including blood tests and fecal sample tests. 

How is Rectal Bleeding Treated?

As you can imagine, the treatments for rectal bleeding can vary widely depending on the cause. For hemorrhoids, over-the-counter creams or a sitz bath may provide relief to the irritated tissue and allow the bleeding to heal. For people who have Crohn's disease, changes in diet and lifestyle may be necessary. For ulcerative colitis patients, drug therapy can sometimes help, although surgical intervention may be necessary. When colorectal cancer or anal cancer is found, more aggressive treatment is required to eliminate the cancerous tissue and prevent the spread of the disease.  

Talk to Your Doctor About Rectal Bleeding

Given the wide variety of causes of rectal bleeding, and the potentially serious diseases like cancer that can cause it, talking to your doctor is essential if your bleeding extends beyond a few days, or is accompanied by other concerning symptoms. Some causes of blood in the stool are not life-threatening, and can be solved by conservative treatment, but if you are experiencing unexplained weight loss, severe abdominal pain, vomiting, or fainting spells, you should seek medical treatment immediately. 

Talking to your doctor sooner rather than later, especially if you are older or have had a history of problems in your digestive tract, could save your life. If you have been experiencing blood in your stool and you are concerned something serious could be wrong, make an appointment at Cary Gastroenterology Associates today.