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Blood in the stool

Dr Karen Martin
Reviewed by Dr Karen MartinReviewed on 19.10.2023 | 3 minutes read

Blood in the stools (your ‘poop’), or rectal bleeding, is where blood is found coming from the anus. You may notice this mixed in with the stool or after you’ve opened your bowels, either on the toilet paper or in the toilet itself. It’s always important to seek medical attention, as this indicates that some part of the gut is bleeding, although most causes are completely harmless.

Your stool may be different colors if there’s been bleeding into it. If it’s bright red, it usually means a bleed somewhere near the rectum whereas darker red stool indicates that there may be bleeding higher up in the gut, or in the lower small intestine. Black, tarry stools indicate bleeding from much higher up, from the stomach or upper small intestine.

What are the causes of rectal bleeding?

Bright red blood is usually caused by a hemorrhoid (‘piles’) or a tear in the anus called an anal fissure and these are most often caused by straining to go to the toilet when you’re constipated. If you’re on medications that thin the blood, like warfarin or aspirin, this can also increase your likelihood of bleeding.

Anal sex can cause trauma that leads to bleeding from the rectum, and sexually transmitted infections from anal sex may also be responsible.

Blood that is mixed in with the poop is caused from issues higher up in the gut. Examples include inflammatory bowel diseases like ulcerative colitis or Crohn’s disease, tummy bugs or anal fistulas.

Blood mixed in with stool can also be a worrying sign of bowel cancer, which is common but more likely in those with a history or family history of colon polyps, or those older than 65 years old.

Dark poop can look black and can be caused by certain foods or medications like iron tablets. Eating beetroot can cause stool to look red, purple or a dark blackish color.

There are more worrying causes of dark black poop, such as bleeding in the stomach or small intestine from a stomach ulcer, diverticulitis, or blood-thinning medications like warfarin.

When should I see my doctor?

If you experience bleeding from the rectum and you can’t identify a cause, such as hemorrhoids that you feel confident treating at home, you should book an appointment with your doctor.

They’ll ask about your symptoms and family history, about certain lifestyle factors like smoking, alcohol intake, diet and sexual activity, and they’ll examine your abdomen (your tummy). With your permission, they will also do an examination of your rectum with a gloved lubricated finger.

Blood tests will be important to look for signs of anemia or infection. Stool samples can also be sent off to look for blood in the stool and can help identify any infections that may be present, or to look for evidence of any inflammation. Further investigations may be required such as procedures like a colonoscopy or imaging such as a CT scan.

When should I seek a doctor urgently?

Rectal bleeding may be associated with rectal pain or abdominal pain or cramping. Urgent medical advice is required for significant loss of blood that leads to dizziness, tiredness, rapid breathing, confusion or fainting.

Additionally, if the rectal bleeding doesn’t stop, if there is severe anal pain or you are also vomiting blood, then you should seek urgent medical attention.

If your symptoms aren’t improving on their own or with medication from your pharmacy, you should always contact your doctor for further review.

How can rectal bleeding be treated?

The treatment of rectal bleeding very much depends on the cause. Hemorrhoids can be treated by over-the-counter remedies. Constipation can be prevented by exercising regularly, drinking plenty of fluids and eating a high fiber diet.

Cancer of the bowel requires specialist treatment and may need a combination of surgery, chemotherapy and radiotherapy to help manage the disease.

Inflammatory bowel disease requires medication and regular reviews by a specialist team.

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This article has been written by UK-based doctors and pharmacists, so some advice may not apply to US users and some suggested treatments may not be available. For more information, please see our T&Cs.
Dr Karen Martin
Reviewed by Dr Karen Martin
Reviewed on 19.10.2023
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