Rectal Bleeding

What is it?

Rectal bleeding (hematochezia) ranges from minor (hemorrhoids, anal fissures) to life-threatening (lower GI bleed from diverticula, colon cancer, or ischemic colitis). Bright red blood on toilet paper or coating stool typically comes from the anus or rectum (hemorrhoids, fissures). Dark red or maroon blood mixed into stool suggests a more proximal colonic source. Black, tarry stool (melena) usually indicates an upper GI bleed. Any rectal bleeding in an adult over 45 or with risk factors warrants colonoscopy.

Common causes

When to see a doctor

• 1Heavy rectal bleeding causing lightheadedness, rapid heart rate, or pallor — seek emergency care
• 2Any rectal bleeding in an adult over 45, or at any age with a family history of colorectal cancer
• 3Blood mixed throughout stool (not just on tissue) — suggests colonic rather than anorectal source
• 4Rectal bleeding with unexplained weight loss, change in bowel habits, or abdominal pain
• 5Black, tarry stools — indicates upper GI bleeding

What you can do

• ✓Increase dietary fiber and fluids to soften stool and reduce straining
• ✓Do not ignore rectal bleeding — even if you suspect hemorrhoids, get evaluated
• ✓Sitz baths (warm water soaks) reduce hemorrhoid pain and swelling
• ✓Avoid straining during bowel movements — use a footstool to elevate feet

Conditions that cause this symptom

Medications that may help

Treatment depends on the underlying cause. Always consult your provider before starting any medication.

Frequently asked questions