Bright Red Blood in Stool: Should I Worry?

The colon, rectum, and anus are lined with blood vessels. Any injury to this tissue can lead to bright red rectal bleeding. Call your healthcare provider for a diagnosis if you see blood in the stool, in toilet water, or on the paper when you wipe. Seek treatment right away if you experience symptoms including trouble breathing, feeling faint, or fever.

What Does Blood in Stool Look Like?

The blood in your stool may be different colors depending upon where in your colon it is located. For example:

Bright red blood in your stool may indicate bleeding in the lower part of the colon.
Darker red blood in the stool usually means bleeding in the higher part of the colon.4Dark or tar-like stool can also indicate bleeding in the stomach.

Your healthcare provider may want to run tests based on the color of your stool.

Causes

Bright red blood on the toilet paper is likely due to mild rectal bleeding. These common conditions can often be treated with at-home remedies but should still be discussed with your healthcare provider. Causes can include:

Hemorrhoids: These swollen blood vessels can be inside or outside of the anus, often during pregnancy or in people straining due to constipation. They are fragile and can bleed but are easy to treat. Hemorrhoids are the number one cause of bright red blood smears on toilet paper.
Constipation: Straining can lead to bleeding when constipation occurs due to a low-fiber diet, dehydration, lack of exercise, pregnancy, medication, and other causes.
Anal fissure: A small split or tear in the lining of the anus that can cause bright red blood in the stool. It may bleed repeatedly and can be extremely painful.
Angioectasias: Angioectasis and other blood vessel malformations are the most common cause of small bowel bleeding in people age 50 and older. They can be treated during an endoscopy procedure, although some may require more complex care including surgery.

Let your healthcare provider know if you are straining to pass bowel movements.

Are There Foods that Cause Red Stool?

Some food can cause red stool, which can resemble blood. This is often because of the dyes in food, though it can naturally occur. These include:

Beets
Candy, like red licorice
Drinks that contain food dyes, like fruit punch or red sports drinks
Foods that contain natural or artificial red food coloring, such as red #40
Red gelatin
Popsicles
Tomato juice or soup

Serious Causes

Bright red blood in the stool can be a sign of multiple noncancerous conditions. Your healthcare provider can help you determine whether your bleeding is a result of one of these conditions:

Inflammatory diseases, including ulcerative colitis, Crohn’s disease, or diverticular disease.Proctitis, often occurring with ulcerative colitis, can follow pelvic radiation treatment.
Rectal ulcers, which can cause bright red blood in the stool. A peptic ulcer can cause GI bleeding, too, but it occurs higher in the digestive tract and blood may be dark instead.
Sexually transmitted infections, with rectal symptoms often missed. One study found that rectal chlamydia was present in 11.8% of samples taken in females who have anal sex with males.
Colon polyps, which typically require colonoscopy to investigate and remove polyp tissue
Untreated bowel infections, such as an Escherichia coli (E. coli) infection, can cause bloody diarrhea and abdominal pain.
Colon cancer can cause blood in the stool. The bleeding usually occurs regularly and gets worse over time. Regular screening for colorectal cancer is recommended for adults who are 45 to 75 years old.

When to See a Healthcare Provider

Any blood in the stool requires a call to your healthcare provider. Additional symptoms that should be evaluated promptly include:

The bleeding is severe and won't stop.
Bleeding persists for more than a few days.
You have foul-smelling stools with a coffee-grain appearance.

Seek emergency care if the bloody stool is accompanied by:

Shallow or rapid breathing
Lightheadedness
Severe nausea
Fainting or loss of consciousness
Fever or drop in body temperature
Clammy and cold skin
Fatigue or tired feeling
Confusion or disorientation

These issues could be linked to serious infection or severe blood loss.

Diagnosis

Diagnosis includes a physical exam to look for any visible causes of rectal bleeding, like hemorrhoids or anal abrasion. Your healthcare provider will discuss symptoms and medical history, and they may order tests that include:

Complete blood count (CBC): This blood test can show how much blood you may have lost and other changes.
Fecal occult blood test (FOBT) or fecal immunochemical test (FIT): These stool tests check for the presence of blood.
Colonoscopy: In this procedure, a healthcare provider uses a scope to look inside the entire colon. This test allows the healthcare provider to see and remove any polyps in the colon lining.
Upper GI endoscopy: This test also uses a scope to visualize and assess the esophagus and stomach, as well as the first part of the intestines in the upper GI system.
Imaging Studies: Images from X-rays, ultrasounds, magnetic resonance imaging (MRI), and computed tomography (CT) scans may show abnormalities.

Following the test(s), your healthcare provider will discuss the findings with you. They may order further testing if imaging found abnormalities. Based on the results, they can develop a treatment plan, as needed.

Questions Your Doctor May Ask

You can prepare for a conversation with your healthcare provider, who may ask these typical questions:

Was the blood in the stool, toilet bowl, or on the toilet paper? How much?
Was the blood bright red or dark red? Do you have other symptoms?
Do you have bowel changes or straining with constipation?
When was your last colon cancer screening or colonoscopy?
Do you have a history of polyps or a family history of polyps?

Treatment

The treatment for bright red blood in stool focuses on the underlying cause. Minor bleeding from hemorrhoids or a fissure often goes away on its own or with at-home care. More serious causes will require medical treatment.

For bleeding due to hard stools and tears, treating constipation is the first step. It includes:

Over-the-counter stool softeners, like Colace (docusate)
Dietary changes to increase fiber intake
Drinking more water
Getting regular exercise can help long term

Some causes, like polyps, can be treated during a colonoscopy. Inflammatory conditions may require prescription medications to relieve the underlying cause of rectal bleeding.

Colorectal cancer typically requires surgery, followed by targeted therapies, including chemotherapy and immunotherapy.

Summary

Bright red blood in your stool can be caused by a wide range of conditions. Often, bleeding during a bowel movement is a clue to benign conditions like hemorrhoids, constipation, or polyps. However, bright red blood in your stool can also be caused by infections, intestinal diseases, and colorectal cancer.

Blood in the stool should always be evaluated by a healthcare provider. To find the underlying cause, your healthcare provider may order blood work and a colonoscopy. Treatment will depend on the cause, and minor rectal bleeding may clear up on its own.