Rectal Bleeding Is 'Very Common', So When Should You See A Doctor?

We need to smash the poo taboo. As one gastroenterologist told HuffPost UK: "I see a lot of people with quite bad symptoms that they've ignored for many months."

As a nation, we’re pretty pants at talking about anything deemed remotely gross – whether that’s pooing, periods or bleeding from our bums. Instead, we suffer in silence in the hope it’ll sort itself out. And, like all the times Brits adopt a stiff upper lip about their issues, this could lead to dangerous territory.

It’s thought as many as one in five people will see blood after having a poo. While it may just be the sign of a minor issue like an anal fissure (or cut) or haemorrhoids (piles), it could also flag something far more serious – such as bowel cancer or inflammatory bowel disease.

Professor Andrew Goddard, a consultant physician and gastroenterologist at Royal Derby Hospital, says despite the fact that rectal bleeding is “very common”, a lot of people with bad symptoms ignore it for months. It’s likely people hold off due to a mixture of embarrassment about going to the doctor’s and optimism that the symptoms will settle, he says.

“It is sadly unsurprising then, that when we find bowel cancer in these people, it is usually quite advanced,” he tells HuffPost UK. “The average patient with bowel cancer waits three to four months before seeing someone.”

So how can you determine whether the blood on your tissue is something to worry about?

If the blood is bright red:

Bright red blood on your tissue or in the toilet bowl indicates the cause is lower down in your bowel – in the rectum or anal canal – says Dr Ben Disney, a consultant gastroenterologist for University Hospitals Coventry and Warwickshire. People don’t tend to associate bright red blood with a sign of something more serious, however it can be if it’s happening persistently.

In roughly 90% of cases, the cause is benign and a result of haemorrhoids or anal fissures, a cut or tear around the anus. (It’s also worth bearing in mind that eating fresh beetroot can stain the water in the pan a pink-red colour).

In some cases, however, bleeding could indicate diverticular disease – where small bulges or sacs form in the wall of the large intestine; or rectal ulcers – where one or more open sores develop in the rectum. Bleeding can also be seen in patients who have previously undergone radiotherapy to the abdomen or pelvis.

With such a wide range of causes, it’s important to get it investigated as soon as possible. Even if the cause is minor, it’s good to know what the problem is – so it’s best to see your GP or speak to a pharmacist to find out. Age is a factor to take into account, here. Younger patients with symptoms of piles or an anal fissure could try an over-the-counter treatment initially or ask a pharmacist for advice, while people over 40 should speak to their GP as soon as possible.

If the bleeding is happening non-stop, the toilet water is turning bright red or you’re seeing large blood clots, you should go to A&E.

“Seeing lots of bright red blood in the pan or on the surface of the poo is less common and slightly more worrying,” says Prof Goddard, who is also president of the Royal College of Physicians. It could be a sign of issues like polyps (small growths on the inner lining of the rectum), inflammatory bowel disease (ulcerative colitis or Crohn’s disease), or bowel cancer.

If the blood is dark in colour:

Dark red bleeding generally indicates that the blood is coming from higher up in the bowel. “The causes of this are broader and can often be more serious in nature,” says Dr Disney.

Possible causes include: bleeding in the stomach; diverticular disease, which is a digestive condition in the large intestine; abnormal blood vessels (angiodysplasia); reduced blood supply to the bowel (ischaemia); inflammatory bowel disease; or bowel cancer.

Anyone with dark red blood in their stools should seek medical attention. “A small proportion of patients may require hospital admission in the first instance for further investigation,” says Dr Disney, “but the majority may need an outpatient appointment with a bowel specialist for further tests.”

Other symptoms to be wary of alongside this type of bleeding include: weight loss, diarrhoea, a change in bowel habit (frequency or calibre of stools), abdominal pain, a family history of bowel cancer or inflammatory bowel disease, intermittent but persistent bleeding, and increasing age – rates of bowel cancer increase above the age of 40.

You might also experience the passing of a very dark or black stool, which can be as a result of a significant bleed from the gullet, stomach, small bowel or even after a big nose bleed. People taking iron supplements get dark stools, says Prof Goddard, but if you aren’t and you’re seeing dark stools in the bowl, medical advice should be sought immediately.

If you’re embarrassed to seek help:

Ultimately, people shouldn’t be putting off seeing their doctor if they’re having persistent issues involving fresh blood, or are experiencing dark red blood in their stools. “It’s much better to be assessed, and in the majority of cases reassured, rather than ignoring the symptoms,” says Dr Disney.

“I’ve seen numerous patients that have delayed seeking medical attention for months or even more than a year – and sadly I’ve often found a serious cause for the bleeding.”

If you do see your GP, you might have to have an examination of your back passage (a doctor will inspect the area with gloves on) or go for further tests such as a colonoscopy. There’s a possibility you might have to send a sample of your poo off for tests.

But it’s better to have 30 minutes of awkwardness rather than 30 years of issues – or, potentially, your life cut short.