When Should You See a Doctor for Rectal Bleeding?

Everyone who has rectal bleeding should go to the doctor. There are numerous causes of rectal bleeding from something simple like hemorrhoids or irritation at the opening of the rectum to bleeding that is caused from something more serious like a cancer or diverticulosis. I would advise everyone to err on the side of caution and go to the doctor if you have rectal bleeding. Now, if you are 20 years old and have a hard bowel movement and you see a little blood and it goes away, I am not worried about that. If you are 20 years old and the bleeding persists, then you should be evaluated by a physician along with anyone over the age of 25 who has rectal bleeding.

The two most common misperceptions that colorectal surgeons hear from patients are the following:

  1. “It was bright red blood, so I thought that meant it wasn’t serious.”
  2. “I thought it was just a hemorrhoid that bled occasionally.”

There are many causes of rectal bleeding, including hemorrhoids, an anal fissure, infection, diverticulosis, an ulcer, inflammatory bowel disease, or cancer. The color of the blood may indicate the origination of the bleeding. For example, bright red blood may mean the source is low in the rectum or colon and dark red blood may indicate the bleeding is higher in the colon or small bowel. Regardless of the color of the blood, you should go to the doctor.

Most of the time the cause of rectal bleeding will be a minor issue, however, it can be something more serious. Colorectal surgeons often see patients who thought that they had a hemorrhoid problem and it turns out to be cancer. Our policy is that we want everyone—except for a very young person with a little smidge of blood that goes away—to be evaluated just to be safe.

I would also recommend being examined by a physician who is a colorectal specialist. Granted, I am a colorectal surgeon, so this may seem biased. However, the truth is that no one is really trained to evaluate the anal/rectal region of the body except a colorectal surgeon. Most general practitioners and general surgeons are not formally trained in this region of the body. This means that even physicians may mistakenly assume that the bleeding is from hemorrhoids. Yet half of the time, it’s not hemorrhoids. I had a woman in my office a few months ago, who complained to her gastroenterologist of rectal pain and bleeding for almost a year. The physician kept giving her suppositories and ointments. When I saw her in the office, her pain was so exquisite that I couldn’t examine her awake. I took her to the operating room to examine her and discovered that she had an anal cancer just inside the rectum.

 You don’t want to ignore rectal bleeding only to discover much later that you are in that 5% to 10% of patients with something more serious like anal or rectal cancer. The only way to determine if your rectal bleeding is a minor issue is to go to the doctor. A qualified physician can often determine the cause of rectal bleeding from the patient history and a small exam at the office. The exam is relatively simple and the physician will sedate the patient or use anesthesia if the patient is pain, so it will not hurt.  If the physician can identify the source of the bleeding, he or she will treat the source and reevaluate the patient in three to four weeks. If the bleeding goes away, then everything is fine. If the physician can’t identify the source of the bleeding or if the bleeding persists after treatment, then the patient will need further evaluation that may include a colonoscopy or a hospital stay.

People don’t like to talk about rectal bleeding or seek help because they are embarrassed are afraid of what the physician may find. My hope is that people will get past these fears and be evaluated when they have rectal bleeding. It may just save your life.