Anal bleeding

Have you noticed you’re bleeding from your bottom? Perhaps you are feeling very worried about what could be the cause.

There are many reasons for anal bleeding; some you will know about and others you may not yet be aware of. In this guide, we answer all your questions about anal bleeding, including what happens when you see a doctor about the bleeding, and what treatment options are available to you.

If you notice rectal bleeding, don’t be embarrassed. It is more common than you think, especially as a one-off occurrence.

How to check if you’re bleeding from your rectum

If you have only passed a small amount of blood from your back passage, and it’s a one-off occurrence, this is not usually a problem.

To check if you’re bleeding from your bottom, take a look at the toilet paper after you wipe. If there is blood on the paper, even just a little, you are probably experiencing rectal bleeding.

You may also have noticed:

• red streaks on the outside of your poo
• pink water in the toilet bowl
• blood in your poo (or bloody diarrhoea)
• ·very dark, smelly poo (which can mean blood is mixed in with your poo)

You may have rectal bleeding which is accompanied by pain, or anal bleeding no pain.

If you experience any of the above, it’s important to get checked out by a specialist, such as a colorectal consultant. In the first instance, you can speak to your GP, who can then pass you to a specialist.

Rectal bleeding is quite common, and often it is nothing to worry about. However, it’s very important to see your GP about the bleeding, rather than diagnosing yourself. There are some very serious issues associated with anal bleeding, so it’s crucial to get yourself checked.

So, what can cause anal bleeding? Lots of things, from straining on the toilet to damage from sex. You may also ask yourself: Can haemorrhoids cause anal bleeding?

Bright red blood in your stools

If you spot bright red blood on the toilet paper, in the toilet bowl or in your poo, it could be due to:

• Piles (haemorrhoids)
• A small tear in your anus, also known as an anal fissure
• Constipation, due to straining when emptying your bowels
• A sexually transmitted infection (STI), such as genital warts
• Damage from anal sex
• A side effect of blood-thinning medicines, such as warfarin or aspirin, or broken blood vessels in the gut (angiodysplasia)

The above is just a small list of what causes anal bleeding. You may find that you have anal bleeding due to another, non-serious issue. The only way to find out for certain is to discuss everything with your GP or colorectal specialist.

Blood and slime in your poo

If you notice blood in your poo accompanied by ‘slime’, common causes of rectal bleeding could be due to:

• Something you have eaten – for example, if you’ve consumed a lot of red foods (including tomatoes), or purple foods (like beetroot)
• An anal fistula (characterised by blood and yellow slime when pooing, as well as chronic bottom pain and pain when emptying your bowels)
• A tummy bug like gastroenteritis (you may see bloody diarrhoea with clear slime, and you may also experience other symptoms, such as sickness)
• An inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis); with these conditions, you may be experiencing tummy cramps, bloody diarrhoea and bloating
• An injury
• Bowel polyps
• An early sign of bowel cancer

With the latter two conditions, you may notice a change in bowel habits (for example, looser stools), and/or blood or slime in your poo, but this may not always be indicative of a serious issue.

Again, try not to worry if you spot blood on the toilet paper, in your poo or in the toilet bowl. Instead, make an appointment with your GP as soon as possible to discuss your symptoms and any concerns you may have. Sometimes, however, it could be a sign of something else, which is why it’s important to get checked out by your GP.

Dark stools or black blood or poo

If your poo is very dark, or you can see black blood or black poo in the toilet bowl, it could be due to:

Taking iron tablets

Eating dark foods regularly, such as blueberries or liquorice, for example

Bleeding in the stomach or gut, due to an injury or a side effect of blood-thinning medicines, including warfarin or aspirin

A stomach ulcer, diverticular disease or diverticulitis (with these conditions, you may notice dark blood or poo with tummy pain or cramps).

You should always book an appointment with your GP if you notice blood in your poo, and you are concerned about your symptoms, but particularly if blood in your stools isn’t a one-off occurrence.

If your poo has been softer, thinner or longer than usual for three weeks, if you have a lot of pain around the bottom, a pain or lump in your tummy, or you are more tired than normal, you should also ring your doctor.

If your child has blood in their poo, make an appointment and get him or her checked over.

If you have lost weight for no reason, that’s another reason to ring the doctor to discuss rectal bleeding and your symptoms and concerns.                                                                              

Many people will feel embarrassed about visiting their GP or a rectal specialist about anal bleeding, but it’s important that you make an appointment to discuss your symptoms.

Do not be worried about how your doctor investigates rectal bleeding. It’s a straightforward process, and whether you see your GP or a specialist, they will have seen plenty of people with the same symptoms as you.

Benign conditions are usually to blame for rectal bleeding. Mr Anwar Owais, a Consultant Colorectal and General Surgeon at The Ridgeway Hospital in Swindon, offers some reassurance for patients who are due to visit the clinic to discuss rectal bleeding symptoms:

“The most common cause of rectal bleeding is due to benign conditions like haemorrhoids.” he says. “However, the reason you would need to see your physician is just to make sure that you’re not one of the very small percentage of people who does have a serious problem.”   

Our consultants see patients with rectal bleeding regularly. While a physical examination may seem daunting to you, it’s a routine part of our consultants’ day and week, and they will put you at ease as soon as you arrive for your appointment.

A straightforward, physical examination

To help diagnose rectal bleeding and it’s causes, our colorectal specialist will ask you a series of questions and may conduct a physical examination of your back passage. It is a painless procedure, during which he or she will insert a gloved finger inside the bottom; it usually takes one to five minutes.

Your doctor may then take a stool sample, which will later be tested for blood.

“The colorectal clinic at The Ridgeway Hospital is a specialist colorectal clinic and most of the patients we see have similar symptoms,” continues Mr Owais. “The team are all very professional, and they do not make any judgements about patients.

They are purely there to help you. “They are used to the examination, and it’s not unusual for everyone who comes to see us to be examined, just like you will be.”

The consultation process will be the same at any Circle Health Group colorectal clinic, and patients needn’t be worried about the examination.

Blood tests, endoscopy, x-rays and more

Other tests may be required, such as blood tests (to check if you have anaemia), with the results giving our consultant an indication of the bleeding and how chronic it is.

An endoscopy may also be required. This procedure allows our consultant to see where the bleeding is happening. A thin, flexible tube called an endoscope is inserted through the rectum to see the areas of concern. A tissue sample or biopsy may be taken, if needed.

You may also require X-rays (which will involve a barium-containing fluid being placed through the rectum); an angiography (where a dye is injected into a vein ahead of a CT scan or MRI); or radionuclide scanning, which may determine where the bleeding is coming from. This will all be discussed at your consultation or follow-up appointment(s).

In most cases, anal bleeding will be due to other conditions besides bowel cancer.

These include infection, piles, irritable bowel syndrome, or an anal fissure (a tear in the anus).

Bleeding from the anus certainly shouldn’t be ignored, though – and you should make an appointment to discuss your concerns, which may offer you all the reassurance you are looking for.

Treatment for rectal bleeding depends largely on its cause.

Often, patients can treat anal bleeding themselves at home. For those patients, we may suggest ointments or suppositories, which can be purchased over the counter in a chemist.

If your upper digestive tract is bleeding, this can usually be controlled by a doctor, who can inject chemicals directly into the problem area. To do this, an endoscope will be used to guide the needle into place.

In some cases, heat may be used to treat (or cauterize) an area that is bleeding. Once the bleeding is under control, you may need to take medicine to ensure it doesn’t return.

Some patients may require surgery for rectal bleeding. For example, someone with severe haemorrhoids may need a haemorrhoidectomy. Your specialist will discuss the need for a treatment like this, though, if he or she believes your haemorrhoids are severe enough.

“If you feel unwell, if there’s a large amount of bleeding which does not stop, and if your problem is continuous, that’s when you should seek urgent medical care,” says Mr Owais.

Get help from 111 now if:

• Your poo is black or dark red
• You have bloody diarrhoea and there is no obvious reason for it.

Call 111 or ring 111.nhs.uk.

Go immediately to A&E if:

You are bleeding non-stop or if there’s a lot of blood (including large clots of blood in the toilet).

If you are a self-paying patient who is experiencing rectal bleeding, you can enquire about the cost associated with the consultation, any tests needed and subsequent anal bleeding treatment here on our website. You can be sure that you will always receive high quality care, which is tailored to you, your symptoms and concerns.

Helping you build your bespoke treatment plan, our team of colorectal specialists will plan your appointments and any medication, pain management, surgery or aftercare needed. You will be provided with a personalised quote, and you’ll be given all the time you need to consider whether you would like to go forward with a specified treatment plan.

By now you’ll be aware that rectal bleeding does not always point to a serious problem.

Related conditions that are common causes of anal pain include:

• piles (haemorrhoids)
• anal fissures or fistulas
• an anal abscess
• inflammatory bowel disease (IBD)
• ulcers
• colorectal cancer

Most people will find that their anal bleeding is caused by a less serious issue than those listed above.

If you are experiencing anal pain, accompanied by bleeding and any other unusual symptoms, seek medical advice to help put your mind at rest.

Have another question or two about rectal bleeding or anal pain? You may well find the answer below…

Can an anal polyp keep bleeding for days?

If you’re wondering what the answer to the question: ‘Can an anal polyp bleed profusely?’ is, we can help.

If you have an anal polyp, you may notice visible blood in your stool – and yes, polyps like this can continue bleeding for days. Always speak to a colorectal specialist if you are experiencing polyps and are worried about rectal bleeding.

Bleeding from the anus should never be ignored.

Is it normal to bleed after anal sex?

Anal sex can indeed be a cause of anal bleeding; straining or tearing a muscle during sexual intercourse can cause bleeding and, as ever, it is important to seek help, especially if the bleeding is accompanied by pain.

Do not be embarrassed about speaking to a rectal bleeding specialist about bleeding after anal sex. Nothing shocks our team, we have seen many patients who are worried about this issue. Our aim is never to judge, but simply to keep you healthy.

Can an anal fissure bleed a lot?

If you have an anal fissure, you may see some blood when you wipe – and this may happen each time you empty your bowels. Again, always speak to a colorectal specialist if you’re worried about an anal tear causing bleeding.

Can anal bleeding come from IBS?

If you have IBS-C – the type of irritable bowel syndrome which is accompanied by constipation – rectal bleeding can be common.

Always pay attention to your own bowel habits, though – and speak to your colorectal specialist or GP if you are worried about anal bleeding.

Can anal bleeding stop and start?

Rectal bleeding may stop on its own – and this is dependent on the cause of your anal bleeding. If you haven’t yet seen a specialist, and you are worried about anal bleeding, book a consultation at your earliest convenience.

Can excess diarrhoea cause anal bleeding?

If you have inflammation in the anus, you may notice some anal bleeding. The same goes if you have constipation and are therefore passing hard stools. If you have blood in your diarrhoea for no obvious reason, seek help immediately by calling 111.

While the anal bleeding you are experiencing may not be a cause for concern, it’s always a good idea to speak to a professional as soon as possible.

Can gastroenteritis cause anal bleeding?

If you have gastroenteritis, you may notice some blood and mucus in your stools. A bacterial or viral infection in the lining of the stomach and bowel, gastroenteritis often causes diarrhoea which may lead to anal bleeding.

Can spicy hot food cause anal bleeding?

Some people may experience an irritated stomach – and diarrhoea – when they eat spicy food. If this is the case, and you already have either haemorrhoids or peptic ulcer disease, you may then notice blood in your stools. Again, always speak to your GP or colorectal specialist about any bleeding you notice in your poo.

Is it normal to bleed anally during periods?

If you have irritable bowel syndrome, your period may affect rectal sensitivity – but in otherwise healthy patients, rectal bleeding does not tend to go hand in hand with the menstrual cycle.

Always speak to your doctor or colorectal specialist if you are worried about anal bleeding while on your period.

Want to book an appointment at Circle Health Group to discuss your concerns about anal bleeding?

Simply use our online booking system to find a hospital in your area and allow our friendly and professional consultants to help put your mind at ease.