Bleeding from the bottom can be an unnerving experience. It happens to about 10 per cent of adults every year and the causes can vary. Most of the time, rectal bleeding presents as small amounts of bright red blood on toilet tissue, meaning it's come from lower down the digestive tract, near the anus. More often than not a small amount of one-off rectal bleeding is not a serious problem.
Other signs that you may be bleeding from the bottom include red or bloody streaks on your poo, pink water in the toilet bowl or extremely dark poo.
We speak to Dr Tony Tham, Consultant Gastroenterologist and Deputy Chair of the British Society of Gastroenterology (BSG) Clinical Services and Standards Committee, about the most common causes of blood in your poo:
1.Haemorrhoids and blood in your poo
Haemorrhoids, also commonly referred to as piles, is a very common condition that can cause pain, discomfort and itching from your rectum. Piles often go away by themselves after a few days, but there are also creams available to ease the discomfort and speed up recovery. Haemorrhoids are 'swollen veins in the rectum that can cause itching and pain. In some cases you can see or feel haemorrhoids around the outside of the rectum,' explains Dr Tham.
Haemorrhoid irritation is one of the most common causes of rectal bleeding and over half of us will experience this at some point, so there's really nothing to be embarrassed about. Even if you suspect the bleeding is from piles, it's still worth visiting your GP as they can perform an examination to determine the exact cause.
2. Anal fissures and blood in your poo
One in 10 people will experience an anal fissure in their lifetime, but some are more prone to tearing than others due to having unusually tight anal sphincter muscles. Often caused by constipation and straining, anal fissures can be extremely painful, but fortunately they tend to be easily diagnosed as they're normally visible during an examination.
'An anal fissure is a tear in the lining of the anus, the opening where your bowel movements come out,' says Dr Tham. 'There is a muscle that wraps around the anus and holds it shut called the anal sphincter. The sphincter gets tense when the anus is injured from an anal fissure.'
Anal fissures often clear up by themselves, but a high fibre diet and drinking lots of water will help it heal quicker and ease the discomfort. Over-the-counter painkillers can also help manage the pain while it heals.
❗️ You should always go to the doctor to investigate blood in your stool, but if it appears sticky and black, or plum-coloured, seek immediate medical attention.
3. Diverticulitis and blood in your poo
Diverticulitis can cause severe, intermittent pain, as well as changes to bowel habits and even a fever. Although usually painless, you may experience what seems like a lot of blood in your stool - which can be shocking. Diverticula pouches are permanent but a high fibre diet and staying well hydrated are the best ways to manage the symptoms.
'Diverticulosis describes the presence of diverticula which is a pouch like structure that can form through points of weakness in the muscle wall of the colon, at points where the blood vessels pass through the wall,' explains Dr Tham. 'Bleeding from a diverticulum can occur when a small blood vessel located within the diverticulum is eroded and bleeds into the colon.'
4. Peptic ulcer and blood in your poo
It's a myth that ulcers are caused by stress. In fact up to 90 per cent of cases are caused by a bacterial infection (Helicobacter pylori), and the rest are normally from medications like steroids or NSAIs. Stress can of course exaggerate symptoms, especially if it causes you to change your diet and lifestyle (eg drinking caffeine and alcohol and smoking).
'A peptic ulcer is a sore that can form on the lining of the stomach or duodenum which the first part of the small intestine,' says Dr Tham. 'Bleeding from ulcers can produce black, tarry motions because the stomach acid turns blood black.'
One of the best things you can do to reduce your risk of a peptic ulcer is to quit smoking. Smoking is linked to a number of health problems, and may affect how your body manages gastric acid levels.
5. Gastroenteritis and blood in your poo
20 per cent of the UK population will experience gastroenteritis every year, often presenting with classic tummy bug symptoms. You may find your stools become very runny, and contain mucus and traces of blood. 'Gastroenteritis is an infection of the intestines and can result from a virus, bacteria or food poisoning,' says Dr Tham. 'The main symptom is diarrhoea and can also include vomiting, tummy pain, diarrhoea, dehydration and blood in motions. Other symptoms can include a high temperature, headache and aching limbs.'
If you find yourself going to the toilet frequently, sometimes the skin around the anus can tear slightly from frequent wiping. This means the blood isn't actually in your stool, or coming from within your digestive tract but merely an unpleasant side effect of your symptoms.
6. Inflammatory bowel disease and blood in your poo
Inflammatory bowel disease (IBD) is not the same as irritable bowel syndrome (IBS), and is also far less common. About 300,000 people are thought to have either Crohn's Disease or Ulcerative Colitis, the two main forms of IBD.
'Inflammatory bowel disease (IBD) is a chronic condition where part of the intestine is inflamed,' explains Dr Tham. 'There are two main types of IBD: ulcerative colitis which affects the large bowel and Crohn's disease which can affect any part of the intestine including the large bowel. Both usually result in diarrhoea, pain, tiredness, weight loss. Blood in the motion usually occurs when the large bowel is affected.'
While there is no cure for the condition, it can be managed through medication and in some cases surgery. For more information, visit Crohn's and Colitis UK.
7. Colorectal cancer and blood in your poo
Cancer is often what first pops into people's heads when it comes to symptoms like blood in the stool, but the chances of this being the cause is actually very slim. Colorectal cancer, also referred to as bowel cancer, is the fourth most common cancer in the UK and over 90 per cent of cases are diagnosed in people over the age of 50 .
'Colorectal cancer is cancer that affects the large intestine or the rectum. Colorectal cancer may not cause any symptoms at first,' says Dr Tham. 'When it does cause symptoms, they can include tummy pain, change in bowel movements e.g. diarrhoea or constipation, blood in the motions, tiredness.'
Assuming cancer will cause unnecessary anxiety and stress, so try not to jump to any conclusions before consulting your doctor.
8. Radiation damage and blood in your poo
The side effects of radiotherapy often present within a few days and can persist for up to two weeks after the end of treatment.
'The medical term for this condition is radiation proctopathy or proctitis,' says Dr Tham. 'It is damage to the rectum as a result of radiotherapy used to treat cancer of the womb, ovaries, prostate or rectum. Symptoms include bright red blood in the motions and/or an urgency to go to the toilet.'
The side effects are unlikely to last long term, but they will all be discussed with you before treatment begins. For more information about what radiotherapy is and how to prepare for it, visit Macmillan.
Last updated: 07-10-19