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What is rectal bleeding?
Rectal bleeding is blood that comes from the anus, on the toilet paper, in the bowl, or in or on the stool. Most of it is caused by hemorrhoids or by a small tear in the anal lining called an anal fissure. Dr. Ihab Herraka, a rectal bleeding doctor in Fort Smith, finds the source at our Main Clinic. That is the reassuring half. The other half is that hemorrhoids bleed exactly the way colon polyps, colorectal cancer, inflammatory bowel disease and diverticular bleeding do. You cannot tell them apart by looking. Getting checked either confirms the hemorrhoid, or catches something more serious early.
Causes
Rectal bleeding almost always traces back to one of a few conditions.
- Hemorrhoids. Swollen veins in the rectum or around the anus, the most common cause, usually producing painless bright red blood.
- Anal fissure. A small tear in the anal lining, causing sharp pain during a bowel movement along with a streak of blood.
- Diverticulitis and diverticular bleeding. Pouches in the colon wall that can bleed suddenly and painlessly, sometimes in a large amount.
- Colon polyps and colorectal cancer. Growths in the colon or rectum that often bleed slowly and without any other symptom, which is why bleeding is never assumed to be something minor.
- Inflammatory bowel disease or proctitis. Inflammation of the colon or rectum, usually with mucus, diarrhea or urgency alongside the bleeding.
- Angiodysplasia. Small, fragile blood vessels in the colon lining that can bleed intermittently, more common later in life.
Symptoms
The details of the bleeding matter, and they are the first thing we ask about at our Fort Smith Main Clinic.
- Bright red blood on the paper, in the bowl, or coating the stool usually comes from the rectum or anus.
- Painless bleeding is typical of internal hemorrhoids; sharp, tearing pain during a bowel movement with a streak of blood suggests an anal fissure.
- Darker red or maroon blood mixed through the stool points to a source higher in the colon.
- Black, tarry, foul-smelling stool suggests bleeding above the colon and needs urgent evaluation.
- Blood with mucus, diarrhea or urgency raises the question of colitis or inflammatory bowel disease. See IBD specialist Fort Smith. See a doctor promptly, even if the amount of blood is small, if any of these apply:
- You are 45 or older
- The bleeding keeps returning, or has lasted more than a week or two
- Your bowel habits have changed, new constipation, new diarrhea or narrower stools
- Unexplained weight loss, fatigue, or anemia found on bloodwork
- A family history of colorectal cancer or inflammatory bowel disease For guidance on true emergencies, see below.
Is this an emergency?
Go to an emergency room for heavy or continuous bleeding, dizziness or fainting, black tarry stools, vomiting blood, or bleeding with severe abdominal pain or fever. If you take a blood thinner and the bleeding does not stop quickly, treat it as urgent. Short of an emergency, bleeding is still worth an appointment rather than a wait-and-see approach if it persists beyond a day or two, keeps recurring, occurs in someone 45 or older, runs in the family, or has no pain at all. Painless bleeding is exactly the pattern colon polyps and colorectal cancer tend to produce, so it should not be assumed to be hemorrhoids just because nothing hurts.
How rectal bleeding is diagnosed
The point of the visit is to locate the source, not guess at it. At the Main Clinic:
- A focused history. The color of the blood, how much and how often, whether it hurts, your bowel pattern, and your medications, including aspirin, NSAIDs and blood thinners.
- An exam. Dr. Herraka inspects the anal area and performs a brief digital rectal exam. Anoscopy, a short lighted scope used in the office, shows the anal canal and internal hemorrhoids directly. More on hemorrhoid symptoms.
- Bloodwork. A blood count checks for anemia, since slow bleeding you never see can lower your iron.
- Colonoscopy. In our on-site endoscopy center, this shows the whole colon and rectum, finds the source, and removes polyps or takes biopsies in the same visit. It is standard at 45 and older, when red flags are present, or when the exam does not explain the bleeding.
- Upper endoscopy when black or tarry stools point to a source above the colon. Finding a hemorrhoid does not automatically end the search: if the story does not fit, we keep looking.
Treatment
Treatment is aimed at whatever is causing the bleeding:
- Hemorrhoids. More fiber and fluid, avoiding straining, and a short course of an over-the-counter cream for symptoms. When bleeding keeps returning, CRH O'Regan hemorrhoid banding is the concrete next step: an in-office procedure that takes about a minute, needs no anesthesia, and resolves bleeding for most patients within a short series of visits.
- Anal fissure. Softening the stool, sitz baths, and prescription ointments that relax the anal muscle. Most fissures heal with this approach.
- Colon polyps. Removed during the colonoscopy that finds them.
- Diverticular bleeding. Often stops on its own, but it needs prompt evaluation, and some cases are treated during colonoscopy or in the hospital.
- Colitis and inflammatory bowel disease. Treatment targets the inflammation itself, with follow-up over time.
- Chronic straining. Constipation drives both hemorrhoids and fissures, so treating it is part of treating the bleeding. See chronic constipation.
What to expect at your visit
Come with the details: when the bleeding started, what it looked like, how often, and whether anything hurt. Bring your medication and supplement list. For most plans, no referral is needed. The visit is a conversation, then an exam. Most patients leave with an answer, or with a plan and a colonoscopy date if we need to see more. Nobody here is surprised or embarrassed by any of it.
Cost & insurance
Office visits and testing for rectal bleeding are covered by most plans when medically necessary. A colonoscopy done to find the source of bleeding is billed as a diagnostic procedure rather than a screening, which can mean a different copay than a screening exam. We accept most major plans, including Medicare and both Arkansas and Oklahoma Medicaid, and the full list is on our insurance page.
Frequently asked questions
I see blood when I wipe. Is it just hemorrhoids?
It often is, but you should not assume so. Colon polyps, colorectal cancer and inflammatory bowel disease can cause bleeding that looks exactly the same. An evaluation either confirms hemorrhoids so they can be treated properly, or catches something else early.
What does the color of the blood mean?
Bright red blood on the paper or coating the stool usually comes from the rectum or anus. Darker red blood mixed through the stool suggests a source higher in the colon. Black, tarry stool suggests bleeding above the colon and needs urgent evaluation. Color narrows things down but does not replace an exam.
Do I need a colonoscopy for rectal bleeding?
Often, yes, particularly if you are 45 or older, if the bleeding keeps returning, or if the office exam does not explain it. Colonoscopy shows the whole colon and rectum, and polyps can be removed during the same exam. Younger patients with an obvious anal cause and no red flags sometimes do not need one.
Can rectal bleeding be a sign of colon cancer?
It can be, which is why bleeding is evaluated rather than assumed. Most rectal bleeding is not cancer. But colorectal cancer often begins as a polyp that bleeds slowly with no other symptoms, and it is far more treatable when found early. For average-risk adults, colon cancer screening begins at age 45.
When is rectal bleeding an emergency?
Go to an emergency room for heavy or continuous bleeding, bleeding with dizziness, weakness or fainting, black tarry stools, vomiting blood, or bleeding with severe abdominal pain or fever. If you take a blood thinner and the bleeding does not stop quickly, treat it as urgent. Bleeding that is not an emergency still needs to be looked at, in the office, not ignored.
What if there is rectal bleeding with no pain?
Painless bleeding is common with internal hemorrhoids, but it is also exactly how colon polyps and colorectal cancer typically bleed, since these growths usually do not cause pain until they are much larger. Painless bleeding should never be assumed to be hemorrhoids for that reason. It needs the same evaluation as bleeding that hurts.
Can I wait and see if it stops?
A single small episode that clearly followed straining or a hard stool, and does not recur, is reasonable to watch for a day or two. Bleeding that persists beyond that, recurs, involves someone 45 or older, runs in the family, or has no clear explanation should be evaluated rather than watched. Waiting does not make the underlying cause go away.
See a rectal bleeding doctor in Fort Smith
Bleeding is easy to explain away, and one visit usually settles it. Call the Digestive & Liver Center of Arkansas Main Clinic at (479) 242-2888 or request an appointment to see Dr. Ihab Herraka at 3416 Old Greenwood Rd, Fort Smith, AR 72903, Monday through Friday, 8:00 to 5:00. We care for patients from Fort Smith, Van Buren, Greenwood, Alma, Barling and Charleston, and from Poteau, Sallisaw and eastern Oklahoma, where Oklahoma Medicaid is accepted.