Minor rectal bleeding refers to the presence of a few drops of bright red (fresh) blood from the rectum that may appear on the stool, on the toilet paper, or in the toilet bowl. It is very common and up to 15% of adults have had minor rectal bleeding during the previous six months. However, rectal bleeding – however minor – should never be ignored as it can also be the sign of a more serious health condition.
The usual cause of minor rectal bleeding is a swollen blood vessel or a small tear around the anus, but there are still several possible causes making a complete evaluation and early diagnosis by your doctor very important. The American Society for Gastrointestinal Endoscopy lists the following possible causes of minor rectal bleeding:
- Hemorrhoids. Also called piles, hemorrhoids are swollen blood vessels in the rectum or anus. These can cause bleeding when passing stools, an itchy feeling around the anus, and sometimes pain.
- Anal fissures. Anal fissures are small tears in the lining of the anal canal. It is thought that most cases of anal fissures are caused when a large, hard stool is passed and damages the anal canal. This problem can also occur in people whose anal sphincter tone (the muscle that controls the anal opening) is too tight and cannot relax to pass the stool. Usual symptoms of an anal fissure are a sharp pain when passing a stool followed by a burning sensation, and seeing bright red blood on the toilet paper.
- An inflammation of the rectum, proctitis can be caused by previous radiation therapy for various cancers, medications, infections, or a limited form of inflammatory bowel disease (IBD). It may cause the sensation that you didn’t completely empty your bowels after a bowel movement, and may give you the frequent urge to have a bowel movement. Other symptoms include passing mucus through the rectum, rectal bleeding, and pain in the area of the anus and rectum.
- Polyps . These are benign growths within the lining of the large bowel. Although most do not cause symptoms, some polyps located in the lower colon and rectum may cause minor bleeding. It is important to remove these polyps because some of them may later turn into colon cancer if left alone.
- Colon or anal cancer. Colorectal cancer is one that starts in the large intestine. It can affect both men and women of all ethnic backgrounds and is the third most common cause of cancer deaths in the United States. Fortunately, it is generally a slow-growing cancer that can be cured if detected early. Most colon cancers develop from colon polyps over a period of several years. Therefore, removing colon polyps reduces the risk for colon cancer. Anal cancer is more rare but curable when diagnosed early.
- Rectal ulcers. This is an uncommon condition that can affect both men and women. Rectal ulcers are associated with long-standing constipation and prolonged straining during bowel movement. In this condition, an area in the rectum (typically in the form of a single ulcer) leads to passing blood and mucus from the rectum. Treatment involves fiber supplements to relieve constipation. For those with significant symptoms, surgery may be required.
Evaluating minor rectal bleeding may involve a visual examination of the anus to look for anal fissures, cancer, or external hemorrhoids, or an internal examination with a gloved, lubricated finger to feel for abnormalities in the lower rectum and anal canal. Colonoscopy may also be done depending on the results of prior evaluation.