Ramesh Proctology
Clinical review: Dr. Ramesh Babu V.C. — MBBS, MS, DPH, PGDM, FICS, FISCP, FIAGES, FMAS, FACRSI
Senior Proctologist & General Surgeon | 40+ Years of Clinical & Surgical Experience | Practising Since 1985
Seeing blood after passing stool can be frightening. One of the most common assumptions is that the bleeding must be due to piles. Haemorrhoids are indeed a common cause of bright-red rectal bleeding, but not every episode of rectal bleeding is caused by haemorrhoids. NIDDK
How can piles cause bleeding?
Internal haemorrhoids may bleed during a bowel movement. Patients may notice bright-red blood on toilet paper, on the outside of the stool or in the toilet bowl. Internal haemorrhoids that have not prolapsed are often not painful, so bleeding may occur without significant discomfort. NIDDK
Anal fissure is another common cause
An anal fissure can also produce fresh red blood, usually together with sharp, cutting or burning pain during or after defecation. The combination of pain plus a small amount of bright-red blood can suggest a fissure, but examination is still important if symptoms persist. FASCRS
Other causes of rectal bleeding
Rectal bleeding may also be associated with inflammation, Crohn's disease, ulcerative colitis, proctitis, diverticular disease, polyps, colorectal cancer, anal cancer and several other gastrointestinal conditions. Mayo Clinic
The appearance of blood alone cannot reliably tell you the cause.
When does bleeding need urgent care?
Seek urgent medical attention if bleeding is heavy or continuous, or if it occurs with significant abdominal pain or cramping. Emergency attention is also warranted if bleeding is associated with dizziness, fainting, rapid breathing, confusion, marked weakness or cold clammy skin. Mayo Clinic
What happens during evaluation?
The clinician will usually ask how long the bleeding has been occurring, its colour and amount, whether there is pain, constipation, diarrhoea, weight loss or a change in bowel habits, and whether there is a personal or family history relevant to colorectal disease.
Evaluation may include inspection of the anal area, digital rectal examination and anoscopy. Depending on the patient's age, symptoms, risk factors and examination findings, further investigation such as sigmoidoscopy or colonoscopy may be considered. Current haemorrhoid guidelines specifically advise complete colonic evaluation in selected patients with rectal bleeding rather than automatically attributing bleeding to haemorrhoids. ASCRS U
Do not keep treating bleeding blindly
Repeatedly applying haemorrhoid creams without confirming the cause can delay diagnosis of a fissure, inflammatory condition or another source of bleeding.
The safest approach is straightforward: bleeding that is recurrent, persistent or unexplained should be assessed.
