What is rectal bleeding?

Rectal bleeding is bleeding from your anus (back passage). You might see it when you go to the toilet and pass faeces (poo). There might be blood in the toilet or on the toilet paper. Or you may not notice anything as the bleeding is very slow.

What are the symptoms of rectal bleeding?

The colour of the blood can be a sign of where the bleeding is coming from.

Bright red blood can mean the bleeding is coming from lower in your bowel. This means the bleeding is closer to your anus (back passage). This can be a sign of haemorrhoids or anal fissures.

Bleeding in your colon (large intestine) can show up as red or a dark red blood. It can be seen mixed in with your faeces.

One cause of this bleeding can be polyps. These are growths on the wall of your intestines. Polyps are usually harmless. Some types of polyps can turn into bowel cancer.

Faeces that are black, like tar, and that have a very bad smell may mean there is a problem higher up in your digestive system. The problem could be in your stomach or duodenum. One reason for black faeces could be a bleeding peptic ulcer (stomach or duodenal ulcer).

What causes rectal bleeding?

There are lots of causes for rectal bleeding. Common causes of rectal bleeding are:

• hard stools (poo)
• haemorrhoids (also known as piles) — this can happen because of constipation
• anal fissure — a small tear in the skin around the opening of the anus

Less common causes of rectal bleeding are:

• colon polyps
• stomach or duodenal ulcers
• bowel infections
• gastroenteritis
• bowel conditions — such as diverticular disease or bowel cancer, Crohn's disease or ulcerative colitis
• sexually transmitted infections (STIs)
• rectal trauma — for example, an injury caused by accident or sexual assault

Deliberate harm or injury

Rectal bleeding can happen from an injury done on purpose.

If you think this is the cause, you should seek help as soon as possible. You could talk to a nurse or doctor at a hospital emergency department.

How is rectal bleeding diagnosed?

Your doctor will talk to you and examine you. The tests for rectal bleeding depend on your age, symptoms and medical history.

The doctor might want to look inside your rectum and bowel. You might also need tests, including:

• Anoscopy — this is when a small instrument is put into your anus. It can let your doctor have a better view.
• Sigmoidoscopy — this is a procedure to look inside of the lower part of your colon (large bowel). It uses a flexible telescope.
• Colonoscopy — a flexible tube is put into the anus. It lets the doctor see the inside of the large bowel (the colon).

Some of these tests are done under sedation and anaesthetic. You may need to go to hospital. Ask your doctor for more information.

When should I see my doctor?

Make an appointment to see your doctor if you have rectal bleeding that lasts more than 1 or 2 days. See your doctor earlier if the bleeding worries you.

You should always get a doctor to check out bleeding from your anus. Bleeding from the anus could be a sign of something serious.

Most people who have rectal bleeding don't have cancer or another serious illness. However, it is important to have rectal bleeding checked out.

When should I seek urgent care?

Seek urgent medical attention if:

• the bleeding is very heavy
• you have signs of shock — this can be rapid, shallow breathing or dizziness, nausea or confusion
• you have black or dark red poo
• your vomit has blood in it
• your vomit looks like coffee grounds
• you faint
• you have a very bad pain in your rectum

You should also go to the emergency department if you have heavy bleeding from your anus and:

• bad stomach pains
• fever
• weakness
• nausea (feeling sick in your stomach)
• you are unable to do a bowel motion (poo)

How is rectal bleeding treated?

Your treatment will depend on what is causing the bleeding.

Self-care at home

For some problems, the treatment could be to make changes to your lifestyle or diet.

Haemorrhoids often settle down quickly after a few days. They often do not need any special treatment.

Haemorrhoids in pregnancy are common. They are often caused by constipation. Try to avoid getting constipated.

If your doctor tells you that you have an anal fissure, you can feel more comfortable by:

• Very carefully wiping your anal area after going to the toilet. Use soft, moist toilet paper or baby wipes. Do not use dry toilet paper.
• Patting the area around your bottom instead of rubbing it.
• Drink plenty of fluids to keep your stool (poo) as soft and well-formed as possible.
• Making sure you eat a healthy diet with plenty of fibre.
• Trying not to strain when passing a stool (doing a poo).
• Having warm baths a few times a day.
• Seeing your pharmacist for creams to reduce the pain.

Medicines for rectal bleeding

If your haemorrhoids are causing you pain or discomfort, talk to your doctor or pharmacist. There are some medicated creams and gels you can buy that can help you feel more comfortable.

Other treatments for rectal bleeding

If your haemorrhoids keep coming back, you can talk to your doctor about having surgery to fit the problem.

Treatment for anal fissures can involve Botox injections or surgery.

Can I prevent rectal bleeding?

There are some things you can do to help prevent some causes of rectal bleeding.

If you have constipation, you can help ease it by:

• drinking plenty of water
• eating fibre-rich foods — such as bran cereals, fruit, vegetables and wholegrain bread
• avoiding processed foods — such as white bread and cheese
• keeping active
• going to the toilet when you need to
• by taking a fibre supplement or stool softener that you can buy from your pharmacist

Do not put creams on the area unless told by your doctor or pharmacist. The wrong type of cream can cause more pain or injury.

All Australians aged between 45 and 74 years are eligible to do a free bowel screening test every 2 years through the National Bowel Cancer Screening Program.

Resources and support

If you are worried about rectal bleeding see your doctor or call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.