Learn more about rectal bleeding: introduction

A small amount of one-off bleeding from the bottom is not usually a serious problem. But a GP can check.

Check if you're bleeding from the bottom

You might be bleeding from the bottom if you have:

  • blood on your toilet paper
  • red streaks on the outside of your poo
  • pink water in the toilet bowl
  • blood in your poo or bloody diarrhoea
  • very dark, smelly poo (this can be blood mixed in poo)

A small amount of one-off bleeding can often go away on its own without needing treatment.

See a GP if:

  • your child has blood in their poo
  • you have had blood in your poo for 3 weeks
  • your poo has been softer, thinner or longer than normal for 3 weeks
  • you're in a lot of pain around the bottom
  • you have a pain or lump in your tummy
  • you have been more tired than usual
  • you have lost weight for no reason

Get advice from 111 now if:

  • your poo is black or dark red
  • you have bloody diarrhoea for no obvious reason

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

Get an urgent GP appointment

A GP may be able to treat you.

Ask your GP practice for an urgent appointment.

Go to A&E or call 999 if:

  • you're bleeding non-stop
  • there's a lot of blood – for example, the toilet water turns red or you see large blood clots

What happens at your GP appointment

The GP will check what's causing your symptoms.

They might:

Important

Bleeding from the bottom is sometimes a sign of bowel cancer.

This is easier to treat if it's found early, so it's important to get it checked.

Common causes of bleeding from the bottom

If you have other symptoms, this might give you an idea of the cause.

Do not self-diagnose – see your GP if you're worried.

Bright red blood on toilet paper, streaks on poo, pink toilet water
Symptoms Possible causes
Bright red blood and pain when pooing, itchy bottom, lumps piles (haemorrhoids)
Bright red blood and pain when pooing – often after constipation a small tear in your anus (anal fissure)
Bleeding with or without lumps, itching or pain sexually transmitted infections (STIs) like genital warts, damage from anal sex
Bright red blood without pain side effect of blood-thinning medication like warfarin or aspirin, broken blood vessels in the gut (angiodysplasia)
Blood in poo or blood with slime

Poo can look like it's mixed with blood if you have eaten a lot of red or purple foods like tomatoes and beetroot.

But it's sometimes a sign of something else. A GP can check if you're worried.

Symptoms Possible causes
Blood and yellow slime when pooing, irritated anus, non-stop bottom pain anal fistula
Bloody diarrhoea with clear slime, feeling and being sick tummy bug (gastroenteritis)
Bloody diarrhoea, tummy cramps and pain, feeling bloated an inflammatory bowel disease (IBD) like ulcerative colitis or Crohn's disease
Blood in poo bleeding in the anus, bowel or lower gut (gastrointestinal tract) from injury or another problem
Blood in poo, change in pooing habits (like looser poo, diarrhoea or constipation), slime with poo bowel polyps, early signs of bowel cancer
Very dark or black blood or poo

Poo can look very dark or black if you:

  • take iron tablets
  • eat a lot of dark foods like licorice and blueberries

But it's sometimes a sign of something else. A GP can do a test to check this if you're worried.

Symptoms Possible causes
Dark or black poo bleeding in the stomach or gut (gastrointestinal tract) – can be from injury or a side effect of blood-thinning medication like warfarin or aspirin
Dark blood or poo with tummy pain or cramps stomach ulcer, diverticular disease and diverticulitis
Dark blood without pain blood-thinning medication like warfarin or aspirin, angiodysplasia (broken blood vessels in the gut)
Content supplied by the NHS website

Learn more about rectal bleeding: haemorrhoids

Piles (haemorrhoids) are lumps inside and around your bottom (anus). They often get better on their own after a few days. There are things you can do to treat and prevent piles.

Symptoms of piles include:

  • bright red blood after you poo
  • an itchy anus
  • feeling like you still need to poo after going to the toilet
  • slimy mucus in your underwear or on toilet paper after wiping your bottom
  • lumps around your anus
  • pain around your anus
See what piles look like
Piles (haemorrhoids) lump.
They can be small lumps, around the size of a pea.
Piles (haemorrhoids) pink or purple.
They can be pink or purple.

Do

  • drink lots of fluid and eat plenty of fibre to keep your poo soft
  • wipe your bottom with damp toilet paper
  • take paracetamol if piles hurt
  • take a warm bath to ease itching and pain
  • use an ice pack wrapped in a towel to ease discomfort
  • gently push a pile back inside
  • keep your bottom clean and dry
  • exercise regularly
  • cut down on alcohol and caffeine (like tea, coffee and cola) to avoid constipation

Don't

  • do not wipe your bottom too hard after you poo
  • do not ignore the urge to poo
  • do not push too hard when pooing
  • do not take painkillers that contain codeine, as they cause constipation
  • do not take ibuprofen if your piles are bleeding
  • do not spend more time than you need to on the toilet

Ask a pharmacist about treatment for piles

A pharmacist can suggest:

  • creams to ease the pain, itching and swelling
  • treatment to help constipation and soften poo
  • cold packs to ease discomfort

Many pharmacies have private areas if you do not want to be overheard.

Find a pharmacy

See a GP if:

  • there's no improvement after 7 days of treatment at home
  • you keep getting piles

Your GP may prescribe stronger medicines for haemorrhoids or constipation.

Ask for an urgent GP appointment or call 111 if:

  • you have piles and your temperature is very high or you feel hot and shivery and generally unwell
  • you have pus leaking from your piles

If there's no improvement to your piles after home treatments, you may need hospital treatment.

Talk to your doctor about the best treatment for you. Treatment does not always prevent piles coming back.

Treatment without surgery

Common hospital treatments include:

  • rubber band ligation: a band is placed around your piles to make them drop off
  • sclerotherapy: a liquid is injected into your piles to make them shrink
  • electrotherapy: a gentle electric current is applied to your piles to make them shrink
  • infrared coagulation: an infrared light is used to cut the blood supply to your piles to make them shrink

You'll be awake for this type of treatment, but the area will be numbed.

You should be able to go home on the same day.

If these treatments do not work, you may need surgery to remove your piles.

Surgery

Surgical treatments include:

  • haemorrhoidectomy: your piles are cut out
  • stapled haemorrhoidopexy: your piles are stapled back inside your anus
  • haemorrhoidal artery ligation: stitches are used to cut the blood supply to your piles to make them shrink

You'll usually need to be asleep for this type of treatment and may need to stay in hospital for more than 1 day.

Go to A&E or call 999 if you have piles and:

  • you're bleeding non-stop
  • there's a lot of blood – for example, the toilet water turns red or you see large blood clots
  • you're in severe pain

Piles are swollen blood vessels. It's not clear what causes them.

Things that make piles more likely:

Content supplied by the NHS website