One of the "red flag" signs GI docs often talk about is the presence of blood in your stool. It's always something you should pay attention to — rather than just hoping it will go away — because it can be an indication that something serious is going on.
But you don't have to panic.
"Seeing blood when you wipe is a pretty common problem — and I think that most people will see this at some point in their life," says Aaron Martin, MD, a gastroenterologist with Jefferson University Hospitals in Philadelphia. "About 90 percent of the time, blood is due to a benign cause," he adds.
Still, even if it's benign, you'll want to address what's going on, at the very least for your comfort. (Anal itching, for example, is no fun for anyone.) Here are five causes and what to do about each.
1. You've Got Hemorrhoids
Hemorrhoids are swollen veins in your anus and rectum, per the Mayo Clinic. There are two types: inside the rectum and external.
"Most people are more familiar with external hemorrhoids, which can be felt [on the outside] and cause the typical symptoms, such as itching, discomfort and pain," Dr. Martin says. You might see some blood when you wipe with these.
Internal hemorrhoids, on the other hand, don't often come with itching and pain, though you might see a small streak of red blood on your stool or when you wipe, he says.
You might not realize that you have hemorrhoids, especially if this is the first time you're dealing with them. One clue that it's hemorrhoids (and not something else)? Your BM habits.
"For the most part, hemorrhoids usually occur in the setting of some kind of constipation or prolonged sitting on the toilet with a lot of straining," Dr. Martin says.
Fix it: These can be readily treated with OTC hemorrhoid creams, soaking in a warm bath and eating high-fiber foods to make stools easier to pass and relieve straining.
2. It Could Be an Anal Fissure
The color of blood you're seeing gives docs clues as to what's going on.
"Small amounts of bright red blood on the toilet paper typically means there's a source of bleeding around the anus or anal canal," Dr. Martin says.
Anal fissures are small tears in the lining of the lower rectum, per the U.S. National Library of Medicine. They happen from large, hard BMs or chronic diarrhea.
Fix it: Luckily, most heal up nicely without treatment. But see your doctor if bleeding lasts longer than a few days.
3. You Have a Colon Polyp
A polyp is a clump of cells on the lining of the colon. These are typically harmless and often don't cause any symptoms at all, per the Mayo Clinic. But they can cause bleeding similarly to fissures or hemorrhoids, blood in the stool or a change in BMs, to constipation or diarrhea.
Call your doctor: Even though most are harmless, some can develop into cancer, so your doctor will likely want to examine and remove them during a colonoscopy.
4. It's IBD
Inflammatory bowel disease (IBD) is chronic inflammation of the GI tract; patients can be diagnosed with Crohn's disease or ulcerative colitis, per the Centers for Disease Control and Prevention.
Seeing some blood on the toilet paper or in your stool is one, but not the only symptom of an IBD flare — diarrhea, bowel urgency, abdominal pain, weight loss and fatigue are others.
Call your doctor: If your doctor suspects IBD, he or she can diagnose you via testing like an endoscopy, colonoscopy, MRI or CT scans.
5. It Might Be Colon Cancer
It's certainly scary to think about, but it's crucial to have even the possibility of colon cancer on your mind — because it will get you to the doctor.
"Usually when patients come to see me, they're most concerned about colon cancer," Dr. Martin says.
He points out that the largest risk factor for developing colon cancer is age. Increasingly, though, colon cancer is appearing in younger people, which is why the American Cancer Society recommends beginning colorectal screening at age 45.
If you're younger, you'll be looking for persistent blood when you wipe, Dr. Martin says.
Call your doctor: "If you're having this over and over, it's occurring with every BM or has been happening for more than one or two weeks, you absolutely need to be evaluated," he says.
And, if you're having other alarming symptoms, including fevers, abdominal pain, night sweats, weight loss or diarrhea along with the blood, make that call ASAP.
Is This an Emergency?
- Mayo Clinic: “Hemorrhoids”
- U.S. National Library of Medicine: “Anal fissure”
- Mayo Clinic: “Colon polyp”
- U.S. National Library of Medicine: “Colonic Polyps”
- Centers for Disease Control and Prevention: “What is inflammatory bowel disease (IBD)?”
- American Cancer Society: “American Cancer Society Guideline for Colorectal Cancer Screening”