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Rectal bleeding means blood passed from the back passage, whether it appears on the tissue, drips into the pan, coats the stool or is mixed within it. It is the commonest reason patients walk into a proctology clinic, and it is also the symptom most often self-treated for months with over-the-counter ointments. The bleeding itself is easy to stop once the source is identified; identifying the source is the part that must not be skipped.
1. Internal haemorrhoids: Painless bright red bleeding, often splashing into the pan, worse with constipation.
2. Anal fissure: A thin streak of blood with sharp pain during and after passing stool.
3. Rectal prolapse: Bleeding with mucus and a mass protruding on straining.
4. Solitary rectal ulcer: Bleeding with mucus and a sense of incomplete evacuation in chronic strainers.
5. Proctitis: Bleeding with urgency and mucus, from infection or inflammatory bowel disease.
6. Rectal polyps and tumours: Blood mixed with stool, altered bowel habit, sometimes anaemia alone.
1. Is the blood on the paper, in the pan, on the stool, or mixed into it?
2. Is it bright red, dark red or black and tarry?
3. Is it painful or painless?
4. Is there mucus, urgency or a change in stool calibre?
5. Is there weight loss, fatigue or a family history of bowel cancer?
These five answers narrow the diagnosis considerably before any examination is done, so it is worth observing carefully for a few days before your appointment. For a fuller explanation of what different bleeding patterns mean, see our page on blood in stool.
Seek urgent care for heavy bleeding with dizziness, palpitations or fainting, or for black tarry stool. See a proctologist promptly if bleeding recurs over weeks, occurs after age 45, is mixed into the stool, or comes with weight loss, anaemia or a change in bowel habit. Bleeding that stops on its own is not proof that the cause has resolved.
1. Establish the source first: Proctoscopy takes minutes in the OPD; colonoscopy is added where the history or age warrants it.
2. Correct the bowel habit: High-fibre diet, adequate water and stool softeners stop the mechanical trauma that keeps most bleeding going.
3. Laser haemorrhoidoplasty: Stitchless daycare treatment that shrinks bleeding internal piles, with rapid return to work.
4. Fissure management: Sphincter-relaxing ointments, and laser fissurectomy for chronic disease.
5. Treat inflammation or lesions: Medical therapy for proctitis, polypectomy for polyps, and prompt referral for anything suspicious.
6. Correct anaemia: Iron supplementation, and transfusion in the rare severely anaemic patient.
Chronic low-grade bleeding is deceptive. Patients adapt to a slowly falling haemoglobin and only notice when they are breathless climbing one flight of stairs. Meanwhile piles enlarge and prolapse, fissures become chronic and fibrotic, and any polyp or early tumour continues on its own timeline regardless of how mild the bleeding seems. A single OPD examination resolves the uncertainty.

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