The Lamen


by | Feb 10, 2023

Seeing blood when you look down into the toilet can be frightening, especially when you don’t know the clear cause. While blood in stool might be an indication of some serious problem with your gastrointestinal (GI) tract, this might not always be the case.

Rectal bleeding, also known as hematochezia, can vary from mild and a one-time occurrence to something serious like cancer.

It might be a symptom of any of the following conditions:

  • anal fissures
  • hemorrhoids
  • peptic ulcers
  • colorectal cancer

Continue reading this article to learn more about the possible causes of blood in stool, how you get diagnosed, and treatments.

What causes blood in stool?

Blood in stool indicates that there is something wrong in your gastrointestinal tract. The GI tract includes organs like the stomach, small intestine, large intestine, and anus.


Hemorrhoids, also known as piles, are swollen veins inside the anus and rectum. They are the most common cause of rectal bleeding, affecting about 1 in 20 Americans. They are common in both men and women, with nearly half the adults over 50 having hemorrhoids.

Everyone is born with hemorrhoids, but they don’t cause any pain or symptoms at baseline. They only cause rectal bleeding when swollen, and can happen inside or outside of your rectum.

While anyone can get hemorrhoids, the following factors increase the risk of developing them:

  • obesity
  • pregnancy
  • a low-fiber diet
  • constipation
  • diarrhea
  • aging
  • irregular or strained bowels
  • excess strain during weightlifting

People with hemorrhoids often experience painless rectal bleeding, and the blood is usually bright red. Other common symptoms include itchiness around the anus and pain when the hemorrhoids start bleeding.

Hemorrhoids may cause complications in some cases, which include:

  • thrombosis (blood clots in hemorrhoid)
  • skin tags
  • anemia
  • strangulated hemorrhoid (blood supply to the hemorrhoid is cut off, causing tissue death)

Speaking with a healthcare provider becomes necessary if you’re experiencing any severe or persistent symptoms.

Anal fissures

Anal fissures are small tears in the lining of the anus or anal canal. These can affect people of any age but are especially common in young infants and women after pregnancy. Possible causes include:

  • chronic constipation
  • prolonged diarrhea
  • straining while having a bowel movement
  • anal sex
  • childbirth

Besides blood in stool, other common symptoms of anal fissures include:

  • pain during and after bowel movements
  • itchiness or irritation around the anus
  • anal spasms
  • constipation
  • a visible crack or tear in the anus

It is easy to confuse anal fissures and hemorrhoids, with both causing similar symptoms, including bleeding, pain, and itchiness. Therefore, it is important to get a proper diagnosis from your healthcare provider if you are experiencing any serious symptoms.


Diverticula are tiny pockets that can form in the wall of your colon. These pouches are prone to infections and inflammation, which can lead to a condition known as diverticulitis – a type of diverticular disease.

The presence of these tiny bulges (diverticula) in your colon is called diverticulosis. The infection of one or more of these leads to diverticulitis, a condition that becomes more common as you age.

Over 30 percent of adults aged between 50 and 59 in the U.S. have diverticulosis, which increases to over 70 percent in people older than 80. However, the instance of diverticulosis developing into diverticulitis is less than 5 percent.

Other symptoms of diverticular disease besides rectal bleeding include:

  • abdominal pain
  • constipation
  • diarrhea
  • fever
  • nausea and vomiting
  • swelling or bloating
  • loss of appetite

Scientists are not sure about what causes diverticular disease but believe that the diverticula are caused by not eating enough fiber. The complications of diverticular disease include:

  • diverticular bleeding
  • abscess
  • fistula
  • intestinal obstruction
  • a hole in your colon (perforation)
  • infection of the lining of the abdominal cavity (peritonitis)

Diverticulitis is usually treated with a combination of antibiotics and a liquid or low-fiber diet. In serious cases, surgery might be required to remove the infected portion of the intestine.

Inflammatory bowel disease (IBD)

Inflammatory bowel disease is a term used for a group of chronic conditions that cause inflammation of the digestive tract. The two main types of IBD are Crohn’s disease and ulcerative colitis.

The exact cause of inflammatory bowel disease is unknown, but researchers believe it is caused by a weakened immune system. They are designated as autoimmune diseases, where your body’s immune system mistakenly starts attacking its own cells.

According to the Centers for Disease Control and Prevention (CDC), an estimated 3.1 million adults in the U.S. have been diagnosed with IBD.

The symptoms of inflammatory bowel disease can come and go. Besides blood in stool, other common symptoms of IBD include:

  • diarrhea
  • abdominal cramping
  • bloating
  • weight loss
  • mucus in stool
  • anemia
  • fever
  • joint pain

IBD is thought to run in families, but might also be triggered by certain environmental factors, such as stress, diet, or smoking. While inflammatory bowel disease cannot be prevented, certain things can help manage the symptoms and complications.


Polyps are small growths of tissue that can be flat, raised (sessile), or on a stalk (pedunculated). A colon polyp is a growth on the inner lining of the colon or rectum, which are usually benign but may turn into colon cancer in some cases.

Colon polyps are very common, with anywhere from 15 to 40 percent of American adults having colon polyps. You have a greater chance of developing them if you:

  • are older than 45
  • have a family history of colorectal cancer
  • have IBD
  • are obese
  • smoke cigarettes
  • consume too much alcohol

Most colon polyps do not have any symptoms. However, when symptoms do manifest, they may include:

  • rectal bleeding
  • blood on underwear or tissue after wiping
  • red streaks in your stool
  • black stool
  • fatigue from anemia
  • irregular bowel movements
  • abdominal pain in rare cases

Most colon polyps when detect early prevent the development of colon cancer. However, because they usually do not show any symptoms, screening is recommended to make sure you have no polyps or colorectal cancer.

Colorectal cancer

Colorectal cancer starts in the colon or the rectum and is the third most common cancer diagnosed (excluding skin cancers) in the United States.

According to the American Cancer Society (ACS), the lifetime risk of developing colorectal cancer is about 1 in 23 (4.3 percent) for men and 1 in 25 (4 percent) for women. Colorectal cancer is the second most common cause of cancer deaths.

Most of these colorectal cancers start as polyps. The following factors can make a polyp more likely to become cancerous:

  • a polyp larger than 1 cm
  • more than 3 polyps
  • dysplasia after polyp removal

While colorectal cancer may lead to rectal bleeding, it may also be present without any visible signs of bleeding. Other symptoms of colorectal cancer include:

  • changes in bowel habits
  • constipation
  • diarrhea
  • abdominal pain
  • bloating
  • weight loss
  • fatigue

A colonoscopy is the most common screening test for colon cancer. The ACS recommends that people at average risk of colorectal cancer start getting regular screening at age 45.

Anal fistula

An anal fistula is a small tunnel that forms between an infected cavity in the anus (abscess) to an opening on the skin around the anus.

There are a number of small glands just inside the anus. If these glands get clogged and infected, they can develop an abscess – a painful collection of pus. When the pus drains away from the abscess, it can leave a small channel behind, which may continue to ooze pus or even blood

If you develop an anal abscess, you have about a 50 percent chance of it developing into an anal fistula.

Besides an abscess, some other conditions may also cause an anal fistula, including:

  • cancer
  • diverticulitis
  • tuberculosis
  • Crohn’s disease
  • Surgery
  • sexually transmitted diseases (STDs)

Anal fistulas have the following symptoms:

  • blood in stool
  • foul-smelling pus from an opening around the anus
  • frequent anal abscesses
  • fever
  • fatigue

An anal fistula almost always requires surgery, as they rarely heal if left untreated. Without treatment, they may lead to complications like recurrence, incontinence, tissue damage, and even death.

Peptic ulcers

Peptic ulcers, also called stomach ulcers, are painful sores that form on the lining of the stomach or duodenum (first part of the small intestine).

Scientists have found two main causes of peptic ulcers: the bacteria Helicobacter pylori or the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Other possible but rarer causes include:

  • surgery
  • serious infections
  • stress
  • alcohol consumption
  • smoking
  • Zollinger-Ellison syndrome (gastrinoma)

Some people with peptic ulcers may not experience any symptoms. Bleeding is generally a severe symptom of ulcers, with stools appearing dark red or black due to bleeding. Other symptoms include:

  • nausea
  • vomiting
  • bloating
  • weight loss
  • heartburn

In rarer cases, peptic ulcers can cause heavy and prolonged bleeding.


There are a number of infections that can lead to blood in stools.

Dysentery, also referred to as bloody diarrhea, is an infection commonly caused by Entamoeba histolytica (amoebiasis) or the Shigella bacteria (shigellosis). The symptoms of dysentery include:

  • diarrhea with blood
  • abdominal pain and cramps
  • watery diarrhea
  • fever
  • fatigue

To identify whether the dysentery is caused by Shigella or Entamoeba, laboratory tests are required. Based on the tests, the doctor will prescribe the appropriate treatment.

Dysentery is usually caused as a result of poor hygiene and is especially common in developing countries where infected stool may contaminate the water supply or food.

Other causes

Other possible causes of blood in stool include:

  • colitis (inflamed colon)
  • proctitis (inflamed rectal lining)
  • angioectasia
  • gastritis (inflamed stomach lining)
  • constipation

Certain infections may also cause rectal bleeding, including:

  • Salmonella
  • Norovirus
  • Rotavirus

Esophageal varices are abnormal, swollen veins in the esophagus that develop when normal blood flow to the liver is blocked. When these varices start to bleed, the person may vomit blood or swallow the blood, causing thick, black stools.

Bleeding esophageal varices are a life-threatening condition.

Medications that may cause blood in stool

Besides health conditions, certain medications can also lead to gastrointestinal bleeding.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently associated with GI bleeding. Besides that, NSAID intake can also increase the risk of developing peptic ulcers and their complications, like bleeding. These include medications like diclofenac and ibuprofen.

Other medications that could lead to rectal bleeding include:

  • Platelet inhibitors such as acetylsalicylic acid (ASS), clopidogrel, prasugrel
  • Anticoagulants such as vitamin-K antagonists, heparin
  • Corticosteroids like prednisone
  • Chemotherapy drugs

GI bleeding is a frequent and serious side effect of patients being treated with anticoagulant or antiplatelet medications. Such bleeding can even be life-threatening ins some cases.

Blood in child’s stool

If you notice some blood in your child’s stool, you’re likely to panic and start wondering if something is wrong. Actually, blood stool is fairly common in infants. The reason behind it may be any of the following:

  • Anal fissures. In 90 percent of children, blood in the stools is caused by an anal fissure. If your child has an anal fissure, you may notice red streaks in their stool, and the blood is always bright red. Blood may also be found on tissues after wiping.
  • Diarrhea. If your child is experiencing bloody diarrhea, it may be caused by a gut infection, caused by something like Shigella, Salmonella, or Campylobacter.
  • Food allergies. Babies can be allergic to certain foods, or they can be allergic to a protein in milk which causes a condition called allergic colitis. Cow’s milk is a common allergen in children, which causes cow’s milk colitis.
  • Inflammatory bowel disease (IBD). Among children with IBD, 4 percent manifest the symptoms before the age of 5 years, and 18 percent before the age of 10 years, with peak onset in adolescence. There are two main types of IBD – Crohn’s disease, and ulcerative colitis. A child with inflammatory bowel disease may experience mucus in the stool, abdominal cramping and pain, and unexplained weight loss.

While blood in your toddler’s stool may be a sign of something serious, such is not always the case. Red drinks, berries, tomatoes, beets, or iron tablets are things that can give their stool a red or black appearance.

Blood when wiping your butt

Sometimes people might experience blood on the toilet tissue after wiping, but not in their stool. Generally, blood when wiping is caused by benign conditions such as hemorrhoids or anal fissures.

In such cases, it is important to avoid strained bowel movements, and use soft, unscented toilet tissues to avoid further irritation.

A few drops or streaks of blood in the toilet or on your tissue when wiping is usually nothing to worry about. However, if you experience large amounts of blood, persistent bleeding, or abdominal cramping and pain, it might be time to consult your healthcare provider.

Blood in stool without any pain

While blood in the stool may be caused by some serious health condition like colorectal cancer, you may also experience painless bleeding at times. This is often caused by hemorrhoids, where the person often does not experience any pain.

The exact cause of blood in your stool can only be determined by a proper diagnosis. In general. If your stool looks like tar and is dark red or black in color, you should consult with your doctor.

What does the color of your stool mean?

The color of your stool can be influenced by a variety of factors, including the food you eat, medications you might be taking, and any underlying health conditions.

The color of your stool is also a clear indication of rectal bleeding, and where the source of this bleeding is.

Bright red stool

Bright red blood in the stool can be a sign of lower gastrointestinal (GI) tract bleeding, which includes the large intestine, rectum, and anus. Diverticulosis is the most common cause of lower GI bleeding, accounting for 30 percent of the cases.

Other causes of lower GI bleeding include:

  • hemorrhoids – 14 percent
  • IBD – 9 percent
  • colon cancer/polyps – 6 percent
  • rectal ulcer – 6 percent
  • radiation colitis/proctitis – 3 percent

In some cases, the blood might not be visible in the stool, and may only be detected through a laboratory test. This is known as occult gastrointestinal bleeding.

Black, tarry stool (Melena)

The passage of black, tarry stools is known as melena, and it indicates bleeding in the upper GI tract. This includes the mouth, esophagus, stomach, and duodenum.

This type of stool has a dark, sticky consistency and is accompanied by a strong, unpleasant odor.

The black color and characteristic odor are caused by the hemoglobin in the blood being broken down by digestive enzymes and intestinal bacteria.

Upper GI bleeding is estimated to occur in 80 to 150 out of 100,000 people each year, with mortality rates between 2 and 15 percent. Peptic ulcers account for up to 50 percent of the cases.

Diagnosing blood in stool

Your doctor may ask you to undergo a series of tests to determine the exact cause of your rectal bleeding.

They may begin by asking about your symptoms, whether you have experienced this before, and if you have a family history of inflammatory bowel disease or colorectal cancer.

The doctor may conduct a physical exam of the rectum, which involves external inspections for conditions like anal fissures, external hemorrhoids, skin tags, and skin diseases. This involves the doctor touching your rectum.

They can also conduct an internal inspection for:

  • internal hemorrhoids
  • rectal carcinoma
  • rectal polyps

Another screening test is called the fecal occult blood test (FOBT), which is often used for screening for colorectal cancer. The doctor takes a stool sample, and checks for the tiniest traces of blood that might not be immediately noticeable.

FOBT alone can’t diagnose colorectal cancer or digestive issues and may require more testing based on results.

One of the most common routine procedures for cancer screening is colonoscopy, a type of endoscopy.

An endoscopy involves the doctor inserting a camera attached to a thin, flexible tube (endoscope) into an opening in your body. For a colonoscopy, the doctor inserts the colonoscope through your anus and rectum into your colon.

Besides a colonoscopy, a doctor may perform another type of endoscopy, including:

  • Virtual colonoscopy. A virtual colonoscopy is a type of CT scan that produces a highly-detained 3D image of your colon.
  • Flexible sigmoidoscopy. A flexible sigmoidoscopy is similar to a colonoscopy, except that the scope is used to view the inside of the sigmoid (lower) colon and rectum.

The ACS recommends that people at average risk of colorectal cancer start regular screening at age 45, which often involves a routine colonoscopy.

People at a higher risk of colorectal cancer might need to start regular screening before age 45 and get more specific tests.

This includes people with:

  • family history of colorectal cancer or polyps
  • personal history of colorectal cancer of polyps
  • personal history of IBD
  • family history of a hereditary colorectal cancer syndrome
  • personal history of radiation to the abdomen or pelvis

Among these screening tests, a colonoscopy is more often recommended because of its higher sensitivity. It does not require any follow-up tests either, and if your results are normal, you will have to retest only after another 10 years.


Treatment for rectal bleeding depends upon the cause of blood in your stools.

Treatment for hemorrhoids

Certain home remedies and lifestyle changes can help you treat your hemorrhoids at home, including:

  • eating high-fiber foods or taking fiber supplements such as psyllium
  • not straining during bowel movements
  • taking a sitz bath (tub of warm water) several times a day
  • drinking plenty of water to avoid dehydration
  • OTC hemorrhoid cream

While most hemorrhoids go away without any treatment, severely prolapsed or bleeding hemorrhoids may require medical treatment, which may include:

  • Rubber band ligation. In a rubber band ligation, the doctor places a special rubber band around the base of the hemorrhoid to cut off the blood supply. The banded hemorrhoid dries up and falls off.
  • Sclerotherapy. The doctor injects a solution into the internal hemorrhoid during sclerotherapy, which causes scar tissue to form. This cuts off the blood supply to the hemorrhoid, shrinking it.

It is important to know that medical treatment for hemorrhoids should only be performed by a doctor.

Treatment for anal fissures

Anal fissures usually heal up without any treatment, or through some home remedies. These include:

  • drinking plenty of fluids to avoid dehydration
  • try a high-fiber diet or fiber supplements
  • take a sitz bath several times a day to relax the anal muscles and relieve pain
  • apply petroleum jelly to lubricate the anus
  • use OTC creams or suppositories to reduce inflammation

While most cases of anal fissures go away on their own in a few days with dietary changes, you should see a doctor if the pain lasts more than a few days, if you see excessive blood in stool, or if home remedies aren’t improving your condition.

Treatment for diverticulitis

Treatment for diverticulitis depends on the severity of the condition. For people who have diverticulitis but no complications, at-home treatment is sufficient.

This involves consuming a diet rich in fiber, while some doctors might as you to limit the consumption of canned or processed foods, refined grains, and dairy.

If you experience severe diverticulitis, diverticulitis with complications, or are at high risk for complications, you might require medical treatment. This might include:

  • a temporary clear fluid diet
  • pain-relieving medications such as acetaminophen instead of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • antibiotics through an IV

If you experience multiple episodes of diverticulitis that are not fixed with dietary changes and medications, the doctor might advise you to get surgery. This may involve drainage of pus or removal of infected segments of the colon.

Treatment for IBD

There is currently no known cure for IBD. However, treatment can help reduce the symptoms to a certain degree and prevent complications. IBD treatment depends upon its type and symptoms.

Certain medications might help you control inflammation, which include:

  • antibiotics
  • anti-inflammatory drugs
  • corticosteroids
  • immune suppressants
  • biologic drugs

Certain OTC drugs such as antidiarrheal medications, vitamins, as well as probiotics might also help manage the condition.

Lifestyle changes are also considered helpful in controlling the symptoms of IBD. These include:

  • Dietary changes. Limiting intake of high fiber foods, drinking plenty of water, keeping a food diary to track inflammatory foods, and eating smaller meals every two to four hours.
  • Stress management. Stress has been shown to be a contributing factor to the development of inflammatory bowel disease. Therefore, meditation and exercise can help in managing the disease.

In case of severe symptoms, a doctor might suggest surgery to treat IBD or any of its complications.

Treatment for colorectal cancer

In treating cancer, a team of doctors often works together to decide on a treatment plan for the patient which usually involves a combination of treatments.

The treatment for colorectal cancer depends upon several factors, including:

  • stage of cancer
  • other medical conditions of the patient
  • the patient’s overall health
  • potential side effects of treatment
  • the patient’s current medication

The earlier a cancer is diagnosed, the better chances there are of the treatment being successful. Local treatments are used when the cancer is detected at an earlier stage, while treatments such as surgery, chemotherapy, immunotherapy, and/or radiation therapy might be used at later stages.

Treatment for peptic ulcers

Peptic ulcers may sometimes heal on their own, but you should see a doctor if you experience symptoms such as blood in the stool.

Doctors typically recommend medications to help the ulcer heal, which may include:

  • proton pump inhibitors (PPIs)
  • histamine receptor blockers (H2 blockers)
  • antibiotics

It can take several weeks of treatment for an ulcer to heal, but taking medicines and treating the underlying cause is typically effective in healing most ulcers.

Treatment for children

If you see blood in your child’s stool, its treatment will depend upon the cause of the bleeding. The most common cause of blood in a child’s stool are anal fissures, which can be treated with certain home remedies.

It is important to clean the area around the anus to prevent infection if your child is experiencing anal fissures.

The doctor may determine the method of treatment after accurately diagnosing the condition, which may involve:

  • blood tests
  • colonoscopy
  • stool culture
  • CT scan

In more serious cases of rectal bleeding, the doctor might recommend antimicrobial medication or even surgery for your child.

Seeing a doctor for blood in your stool

Anytime you notice blood in your stool, it is a good idea to see a doctor. Rectal bleeding can be a warning sign for some serious underlying conditions which might require medical treatment.

The general warning signs associated with rectal bleeding include:

  • dark, thick blood
  • large amounts of blood
  • tar-like stool that appears black
  • worsening abdominal pain
  • dizziness, nausea, or vomiting
  • a rapid heartbeat
  • shortness of breath

Non-stop bleeding is a medical emergency and can be life-threatening. In case a person experiences this or any other serious symptoms with rectal bleeding, they should seek emergency medical assistance.

The gist

Rectal bleeding, also known as hematochezia, can be caused by a variety of factors, including benign conditions such as hemorrhoids, to more serious conditions such as colorectal cancer. While it may often be caused by nothing serious, it is always good to consult a doctor.

In case you notice rectal bleeding along with accompanying symptoms such as abdominal pain, weight loss, lightheadedness, or blood in the urine or vomit, it is best to speak with your healthcare provider.