Rectal Bleeding
CAUSES, SYMPTOMS & diagnosis of:
Rectal Bleeding
Private Rectal Bleeding Diagnostics Specialist in Chester
Seeing blood in your poo can be worrying. While rectal bleeding is often caused by treatable conditions such as haemorrhoids or anal fissures, it should never be ignored. Mr Peter Asaad provides expert assessment to identify the cause and, where needed, exclude more serious conditions such as bowel polyps, inflammatory bowel disease or bowel cancer.
SYMPTOM
What is Rectal Bleeding?
Rectal bleeding simply means passing blood from your back passage (anus).Â
You may notice the following:
- Bright red blood on the toilet paper
- Blood in the toilet bowl
- Blood mixed with your stool, or;
- Occasionally darker blood.
Some people experience bleeding every time they open their bowels, while others only notice it occasionally.
Although seeing blood can be alarming, most cases are caused by common, non-cancerous conditions such as haemorrhoids (piles) or an anal fissure (a small tear in the lining of the anus). However, rectal bleeding can sometimes be a sign of a more serious condition, including bowel polyps, inflammatory bowel disease or bowel cancer. For this reason, persistent or unexplained bleeding should always be assessed.
The colour, amount and pattern of the bleeding, together with any associated symptoms, often provide important clues to the underlying cause. During your consultation, Mr Peter Asaad will ask detailed questions about your symptoms before deciding whether an examination or further investigations are required.
Causes
Common Causes of Rectal Bleeding
There are many possible causes of rectal bleeding. Most are benign and easily treated, but some require further investigation. The most common causes include:
Haemorrhoids are swollen blood vessels inside or around the anus and are one of the commonest causes of rectal bleeding. They typically cause bright red blood on the toilet paper or in the toilet bowl after opening your bowels. They may also cause discomfort, itching, swelling or a lump around the anus.
An anal fissure is a small tear in the lining of the anus. It usually causes severe pain during or immediately after passing a bowel motion, often followed by a small amount of bright red bleeding. Most fissures heal with appropriate treatment, although some become chronic and require intervention.
Although bowel cancer is a much less common cause of rectal bleeding than piles or fissures, it is an important diagnosis not to miss. Bleeding may occur on its own or alongside symptoms such as a persistent change in bowel habit, unexplained weight loss, abdominal pain or iron deficiency anaemia.Â
Small pouches can develop in the wall of the colon, particularly with increasing age. These are known as diverticula. Occasionally, they can bleed, sometimes causing a surprisingly large amount of bright red blood. Bleeding often settles on its own but may require investigation or treatment.
Polyps are small growths that develop on the lining of the bowel. Most are harmless, but some can develop into bowel cancer over time. Polyps do not always cause symptoms, but they can sometimes cause intermittent rectal bleeding. They can usually be removed during a colonoscopy.
Conditions of Inflammatory Bowel Disease such as ulcerative colitis and Crohn’s disease can cause inflammation of the bowel, resulting in rectal bleeding, diarrhoea, abdominal pain and urgency. These conditions require specialist assessment and long-term management.
When is rectal bleeding an emergency?
Most cases of rectal bleeding are not a medical emergency. However, some symptoms may indicate a more serious condition and require urgent medical assessment.
If you are concerned that your symptoms may represent a medical emergency, you should attend your nearest Emergency Department or call 999 without delay.
You should seek immediate medical attention if you experience:
- Heavy or ongoing rectal bleeding
- Large blood clots
- Feel faint, dizzy or collapse
- Severe abdominal pain or become acutely unwell
- Black, tarry stools
When to seek help
When should Rectal Bleeding be investigated?
Most cases of rectal bleeding are caused by benign conditions such as piles or an anal fissure. However, it is important to establish the cause so that appropriate treatment can be offered and more serious conditions can be excluded where necessary.
A specialist assessment can often identify the underlying cause through a careful history and, where appropriate, further investigations.
You should arrange an assessment if the bleeding:
- Is new or unexplained.Â
- Persists or keeps recurring.Â
- Is becoming more frequent or heavier.Â
- Is affecting your quality of life.Â
- Is associated with a lump, pain or discharge from the back passage.Â
You also have:
- A change in your bowel habit.Â
- Blood mixed within the stool.Â
- Abdominal pain.Â
- Unexplained weight loss.Â
- Iron deficiency anaemia or persistent tiredness.Â
- A family history of bowel cancer or inflammatory bowel disease.
Diagnostics
How is Rectal Bleeding investigated?
The most appropriate investigations depend on your symptoms, medical history, examination findings, age and any associated risk factors. Following a detailed consultation, further investigations are often recommended to identify the underlying cause of your symptoms.
The first step is a consultation to understand your symptoms and identify the most likely cause. Mr Peter Asaad will ask about the pattern of your bleeding, your bowel habit, any associated symptoms, your medical history, and any family history of bowel disease. An examination may also be recommended where appropriate.
Stool tests may be arranged to look for signs of infection, inflammation, blood within your stool.
Blood tests may be arranged to check for anaemia, infection or inflammation, depending on your symptoms. These can provide useful additional information and help guide further investigation.
If required, a flexible sigmoidoscopy can be performed to examine the rectum and lower part of the large bowel using a thin, flexible camera. It is often recommended when symptoms are thought to arise from the lower bowel and can diagnose conditions such as haemorrhoids, polyps, inflammatory bowel disease and rectal cancer.
If appropriate, a colonoscopy can be used to examine the entire large bowel and is the most comprehensive investigation for rectal bleeding. It allows bowel polyps to be removed, biopsies to be taken, and conditions such as bowel cancer and inflammatory bowel disease to be diagnosed.
Treatment
Conditions that may require surgical treatment
Not all causes of rectal bleeding require surgery. In fact, many patients can be treated with lifestyle changes, medication or minimally invasive procedures. However, some conditions may require surgery depending on the underlying diagnosis and severity of symptoms.
These include:
- Haemorrhoids (Piles) – If symptoms persist despite conservative treatment, options such as rubber band ligation (banding), HALO or haemorrhoidectomy may be recommended.
- Anal Fissure – If symptoms continue despite medication, procedures such as Botox injections or lateral internal sphincterotomy may be appropriate.
- Bowel Cancer – If bowel cancer is diagnosed, treatment is tailored to the individual and may include surgery, chemotherapy, radiotherapy or immunotherapy.
- Inflammatory Bowel Disease – If inflammatory bowel disease is suspected or diagnosed, Mr Peter Asaad will arrange prompt referral to the appropriate specialist team. Surgery is only required for selected patients with severe disease or complications.
- Diverticular Disease – When an operation is required for diverticular disease, it is more commonly because of recurrent attacks of diverticulitis or complications such as narrowing of the bowel (a stricture), perforation or fistula formation, rather than the bleeding itself.
Following assessment and any necessary investigations, the most appropriate treatment can be recommended. This may involve conservative management, surgery where appropriate, or referral to another specialist.
Where surgery is required, some procedures are well suited to private treatment, while others are more appropriately performed within the NHS, particularly if they are complex or require input from a wider multidisciplinary team. This will always be discussed with you, and recommendations will be based on what is in your best interests.
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Common conditions treated:
About
Mr Peter Asaad
Mr Peter Asaad is a Consultant General and Colorectal Surgeon with over 17 years’ experience in the NHS.
He specialises in colorectal surgery and the treatment of bowel conditions, alongside common general surgical problems such as hernias and gallstones. His practice includes advanced keyhole techniques for colorectal cancer and the management of conditions such as haemorrhoids, fissures and fistulas.
He sees patients within Wrightington, Wigan and Leigh NHS Trust and privately in Chester.
Mr Asaad provides clear, pragmatic advice and a straightforward approach to treatment, ensuring patients understand their options and can proceed with confidence.
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What Patients Say
Frequently Asked Questions
These are some of the most common questions patients ask about rectal bleeding. As new questions arise, this section will be updated to provide clear and relevant information.
Is blood in my poo always serious?
No. Most cases of rectal bleeding are caused by benign conditions such as haemorrhoids (piles) or an anal fissure. However, persistent, recurrent or unexplained bleeding should always be assessed, as it can occasionally be a sign of a more serious condition.
What causes rectal bleeding?
Rectal bleeding has many possible causes. The most common include haemorrhoids (piles), anal fissures, diverticular disease and inflammatory bowel disease. Less commonly, it may be caused by bowel cancer. The first step is establishing the underlying cause so that appropriate treatment can be recommended.
Can piles cause rectal bleeding?
Yes. Haemorrhoids are one of the most common causes of rectal bleeding. They typically cause bright red blood on the toilet paper or in the toilet bowl after opening your bowels and may also be associated with discomfort, itching or a lump around the back passage.
Why do I have blood when wiping after a bowel movement?
Blood on the toilet paper is most commonly caused by haemorrhoids or a small tear in the lining of the anus (an anal fissure). Although these conditions are usually not serious, new or persistent bleeding should be assessed to confirm the diagnosis and ensure there is not another underlying cause.
What does bright red blood from the back passage mean?
Bright red blood usually indicates that the bleeding is coming from the lower part of the bowel or the back passage. Common causes include haemorrhoids, anal fissures, diverticular disease and inflammatory bowel disease. Although the colour of the blood can provide useful clues, it does not confirm the cause, so persistent or unexplained bleeding should be assessed.
Can bowel cancer cause rectal bleeding?
Yes. Rectal bleeding can be a symptom of bowel cancer, although it is far more commonly caused by non-cancerous conditions. If bowel cancer is suspected, further investigations will be arranged to establish the diagnosis and ensure you are referred promptly to the appropriate specialist team.
When should rectal bleeding be investigated?
Rectal bleeding should be investigated if it is new, persistent, recurrent, unexplained, becoming more frequent, or affecting your quality of life. It should also be assessed if it is associated with symptoms such as a change in bowel habit, abdominal pain, unexplained weight loss or iron deficiency anaemia.
What tests may be needed?
Not everyone requires investigations. Depending on your symptoms, I may recommend blood tests, a flexible sigmoidoscopy or a colonoscopy. The most appropriate investigation will depend on your symptoms, medical history and examination findings.
Will I need a colonoscopy?
Not necessarily. Many patients do not require a colonoscopy. Depending on your symptoms, a flexible sigmoidoscopy may be more appropriate, and some patients do not need a camera test at all. Following your consultation, I will recommend the most appropriate investigation based on your individual circumstances.
Should I see a specialist if the bleeding has stopped?
Yes, in some circumstances. Even if the bleeding has settled, it is still worth seeking assessment if it was unexplained, has happened more than once, or was associated with other symptoms such as a change in bowel habit or weight loss. Identifying the cause is often more important than whether the bleeding is still present.
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