If you notice blood in your stool or when you wipe, it’s natural to feel worried — and maybe a little embarrassed to tell anyone, even your doctor. But it’s important to recognize when something isn’t right and to know when you should speak to a healthcare provider.
“Talking about bathroom concerns can be uncomfortable,” says MSK colorectal surgeon Maria Widmar, MD, MPH. “But it’s a vital part of your health that you need to pay attention to, at any age.”
In this article, Dr. Widmar answers common questions about rectal bleeding and offers insights on when to talk to your doctor about your symptoms.
Blood and Your Bowel Movements
“Seeing blood when you use the bathroom is never normal,” Dr. Widmar says. “It could be caused by something benign, meaning not cancer. But it’s definitely worth paying attention to and speaking about with your doctor.”
She also urges people to be persistent: “If you are given treatment for rectal bleeding and it continues after two weeks, let your physician know, as more testing may be indicated. You should be your own best advocate.”
What Counts as a Warning Sign for Colorectal Cancer?
Any of these symptoms deserve a conversation with your doctor:
- New bleeding that’s ongoing.
- Bleeding that stops but returns.
- Changes in bowel habits that last several days without clearing up.
- One-time occurrence: If bleeding happens once and never returns, there may be less cause for concern. However, any pattern of bleeding warrants medical attention.
Hemorrhoids and Rectal Bleeding
One common cause of rectal bleeding can be swollen hemorrhoids. These are not cancer but may need treatment.
What are hemorrhoids?
Hemorrhoids are blood vessels located in the anal canal.
- Everyone has them: Hemorrhoids are veins that are naturally present in your body.
- They’re not always a problem: Hemorrhoids cause symptoms when they are swollen.
- There are two types of hemorrhoids: Internal hemorrhoids (inside the anal canal) and external hemorrhoids (at the anal opening).
Recognizing Swollen Hemorrhoids
When hemorrhoids become swollen, they can cause a range of symptoms.
External hemorrhoids may:
- Feel like a soft, rubbery mass at the anal opening.
- Feel like a hard protrusion when the vein becomes very swollen and gets stuck outside the body.
- Cause pain, especially when the hemorrhoid is trapped outside.
Internal hemorrhoids may cause:
- Bleeding without a palpable mass.
- Symptoms that require an internal exam to diagnose properly.
What Causes Hemorrhoids?
The main culprit behind hemorrhoid problems is increased pressure in the anal canal, typically from:
- Constipation
- Straining during bowel movements
How Are Hemorrhoids Treated?
- Soluble fiber supplements
- Drinking more water
- Stool softeners
This bowel regimen helps reduce straining and constipation, which resolves hemorrhoid issues for many patients.
Understanding the Difference Between Hemorrhoids and Cancers Related to Rectal Bleeding
Anal Cancer Risk Factors
Anal cancer risk factors include:
- Human papillomavirus (HPV) infection
- Receptive anal intercourse
- HIV infection
Rectal Cancer Risk Factors
Rectal cancer shares risk factors with colon cancer — they are often grouped together as colorectal cancer. Risk factors can include:
- Diseases such as inflammatory bowel disease, ulcerative colitis, and Crohn’s disease.
- Obesity and a diet high in animal fat and low in fiber.
- Genetic conditions such as Lynch syndrome that are passed down from parent to child and raise the risk of colorectal and other cancers.
How Is the Cause of Rectal Bleeding Diagnosed?
Initial Examination
Diagnosis typically begins with:
- A digital rectal exam in a doctor’s office.
- Visual examination (swollen hemorrhoids can sometimes be seen externally).
When Further Testing Is Needed
If there’s any possibility of cancer, or if a patient is due for routine screening anyway, the next step involves endoscopy.
- Flexible sigmoidoscopy: A short flexible tube with a camera on the end of it, which is used to examine the rectum.
- Full colonoscopy: Examination of the entire colon using a longer flexible tube with a camera at the end of it. This device also has a tool that can remove polyps. Polyps are small growths in the rectum or colon that can turn into cancer.
Important Note About Home Screening Tests for Colorectal Cancer
Dr. Widmar stresses that “home screening tests like Cologuard or FIT tests are designed for screening people at average risk without symptoms. If you’re already experiencing bleeding, you’re past the screening phase and into the diagnostic phase. That means you need to speak to a physician.”
Special Considerations for People Under 45
The current age to begin screening for colorectal cancer for people at average risk is now 45. But Dr. Widmar urges people of all ages to pay attention to signs that something isn’t right.
“We’re seeing a rise in rectal cancer among people who are 45 and younger,” she says. “If a person in that age group has rectal bleeding and treatment for hemorrhoids isn’t stopping it after two weeks, more investigation is necessary. We used to think this was a cancer of the elderly, but that’s just not the case anymore.”
Learn more about MSK’s Center for Young Onset Colorectal and Gastrointestinal Cancer
Key Takeaways
- Pay attention to changes: Your body is telling you something when symptoms such as rectal bleeding appear.
- Speak up: Don’t stay silent due to embarrassment.
- Persist if needed: If you receive conservative treatment but bleeding continues, ask for further testing.
- Remember the odds: More likely than not, your symptoms are due to something benign — but ignoring them isn’t worth the risk.