Bleeding from the rectum is a common problem. Usually the complaint is “red blood” on the toilet paper or in the bowel. Clots may be seen at times as well. If it is a small or moderate amount, it may be due to hemorrhoids, but there are many other causes of bleeding that need to be considered, depending on the patients age (but not their sex). In young patients under age 30 the next most common causes of bleeding is from proctitis, ulcerative colitis, Crohn's disease or juvenile polyps. After age 30, one must also consider adenomatous polyps and colon cancer. After age 50, all of the above are considerations, but diverticular bleeds and angiodysplasias are additional possible causes.
If blood is found to be mixed into the stool this is suggestive of bleeding from a polyp or growth in the colon.
The best examination for any source of red blood or clots from the rectum is Colonoscopy (see COLONOSCOPY in the patient information section). Most bleeding is not in large volume (although when it is blood in the toilet bowl always looks like a lot) and can be evaluated as an outpatient. If you are having 4-5 large volume bloody stools in a day, you will likely need to be hospitalized and observed to see if blood transfusion is necessary.
Be aware that if you are over age 40 and have rectal bleeding more than once, you should undergo Colonoscopy to rule out cancer and polyps.
As it turns out, hemorrhoids are the source of bleeding much of the time, but nobody ever died of hemorrhoids. The same can’t be said for colon cancer. (See Colon Cancer Screening).
Red blood per rectum associated with a painful bowel movement is likely due to an anal fissure or internal hemorrhoids.
Dark red rectal bleeding may be due to a cause on the right side of the colon, or in the small bowel. Colonoscopy and possibly small bowel x-rays will be necessary to fully evaluate such complaints. Finally, if bleeding occurs more than a few times, do not ignore it, since it may be the first sign of a serious problem.