Anal bleeding

Anal bleeding can affect anyone of any age, including children. You may notice blood on toilet paper, in the toilet bowl or in stools, which may be darker than normal.

Seek urgent medical attention if:

• Your stools are black
• You have bloody diarrhoea
• There’s a worrying amount of blood

A small amount of anal bleeding which goes away on its own isn’t usually something to worry about. Anal bleeding that continues for over three weeks, or heavy anal bleeding, should be checked by your GP. After diagnosing the cause of your anal bleeding, your GP will be able to offer treatment.

If you notice streaks of bright red blood after passing a stool, you may have haemorrhoids (piles). Haemorrhoids are swellings inside or around your anus (bottom) which can also cause itching, redness and anal pain. Haemorrhoids are more likely if you’re constipated or pregnant.

Anal bleeding can be caused by an anal fissure – a small, painful tear in the skin around your anus (bottom). In some cases of irritable bowel syndrome (IBS), regular constipation causes anal fissures and, as a result, anal bleeding.

If you also have a discharge from your anus, you may have an anal fistula. This is a painful condition where a tunnel, usually due to infection, develops between your anus and your rectum.

Anal bleeding can be a symptom of several bowel conditions, including:

• Colorectal polyps – benign (non-harmful) tumours in the colon (large bowel)
• Proctitis – rectal inflammation
• Inflammatory bowel disease – a chronic (long-term) condition which inflames the lining of the colon
• Rectal prolapse
• Damage to the rectum, perhaps by a foreign body
• Certain cancers, including bowel cancer
• Anal abscess

Your GP will ask about your anal bleeding, any other symptoms and your general health, including any unexplained weight loss. Your GP may examine your anus, request a stool sample and carry out a rectal examination.

Your GP may refer you for further investigations or to a consultant, perhaps a gastroenterologist or colorectal surgeon.

For bleeding haemorrhoids, your GP may suggest minor surgery. If your anal bleeding is caused by an anal fissure, your GP may prescribe laxatives, a special cream or medication.

You can reduce the risk of further anal fissures and bleeding haemorrhoids by avoiding constipation and trying not to strain when passing stools. Try:

• Increasing the amount of fibre in your diet
• Increasing your fluid intake
• Exercising more

To treat an anal fistula, your GP or consultant will recommend surgery, which will allow the tunnel to heal.

If another underlying condition is responsible for your anal bleeding, your GP or consultant will recommend treatment depending on your diagnosis.