Rectal bleeding: Is it hemorrhoids or something else?

George Blestel, MD

Colon and Rectal Surgery

Seeing a little blood on the toilet tissue is something we’ll all go through at some point. Most people shrug it off as a symptom of hemorrhoids, but could it be something more serious? Colon and rectal surgeon George Blestel, MD, explained what to know about hemorrhoids and rectal bleeding.

What are hemorrhoids?

Hemorrhoids are swollen veins in the anus and rectum.

“Everyone is born with hemorrhoids,” Dr. Blestel explained. “It’s only when they become symptomatic that they’re a problem. Symptoms include pain, bleeding and protrusion.”

What causes hemorrhoids?

The most common causes of hemorrhoids are bowel irregularity, straining to use the bathroom or abnormal physical activity where someone is holding their breath and pushing against their abdominal wall.

“This activity increases the pressure in these blood vessels, which makes the hemorrhoid tissue protrude out and become engorged, causing bleeding,” Dr. Blestel said.

Can you treat hemorrhoids at home?

Mild cases often can be managed at home by using remedies such as taking a sitz bath or applying over-the-counter hemorrhoidal creams, drinking more water, eating more fiber and exercising regularly.

These small remedies can help relieve immediate symptoms, but if you continue to have bleeding, reach out to your physician.

How long can I wait before seeing a doctor about rectal bleeding?

“If the bleeding persists for more than 10 days, it warrants a visit with your physician,” Dr. Blestel said. “There are people who have symptomatic hemorrhoids who continue to have occasional episodes of bleeding and don’t necessarily need to undergo surgery. But it’s best to have a good workup to make sure the bleeding is truly coming from their hemorrhoids and not something that is potentially life threatening.”

What are some other common causes of rectal bleeding?

Besides hemorrhoids, here are some common causes of rectal bleeding:

• Colorectal cancer. Cancer tends to have bleeding because it has new blood vessels and those blood vessels are not strongly supported, so they tend to open up and bleed.

• Diverticula. This is where the muscle wall gets weaker and causes little pouches to form. Those pouches can spontaneously bleed or get infected (called diverticulitis) which can also cause bleeding.

• Inflammatory bowel disease. Diseases like Crohn’s disease or ulcerative colitis can sometimes present with rectal bleeding.

• Problems with blood vessel anatomy. Trouble with the blood vessels and how they’re formed can cause rectal bleeding. This issue can be acquired or be present at birth.

If you have rectal bleeding, it’s very likely to be caused by hemorrhoids, but ruling out these other issues is important, especially if it’s a new or persistent problem. A colonoscopy may be recommended, as well as lab work.

What you don’t want to do is ignore rectal bleeding. Talk to your doctor.