- If the bleeding when you wipe coincides with constipation, you may have anal fissures.
- Hemorrhoids may also cause rectal bleeding, irritation, and pain in your anus.
- If the blood loss is significant, you should suspect diverticulitis and see a doctor ASAP.
It's alarming if you notice blood on the toilet paper when you wipe after pooping, especially if it's the first time this is happening to you. You may notice blood on the toilet paper, drops of blood in the toilet, or blood mixed in with your poop.
The causes of blood when you wipe range from benign to more serious. It's important to take note of any other symptoms that occur along with the bleeding and talk to your doctor to determine the cause.
Here are seven potential reasons for experiencing blood when you wipe.
1. Hemorrhoids
One of the most common causes of seeing blood when you wipe is hemorrhoids –– swollen veins under the skin just inside or outside of the rectum, says Dr. Jesse P. Houghton, the senior medical director of gastroenterology at SOMC Gastroenterology Associates.
You may see bright red blood on the toilet paper, or have drops of blood in the toilet after a bowel movement, Houghton says. Aside from bleeding, you may also have symptoms like pain, swelling, itching, and irritation around the area.
How to treat it: Treatment depends on the severity of your hemorrhoids. In many cases, minor at-home changes can help, says Dr. Roy Tomas DaVee, a gastroenterologist UTHealth Houston and Memorial Hermann.
DaVee says some of these include:
- Fiber supplements
- Stool softeners
- Drinking plenty of fluids
- Eating a high-fiber diet with plenty of fruits and vegetables
- Spending the least amount of time on the toilet as possible to prevent enlargement or prolapse of the hemorrhoids
However, with larger, more severe hemorrhoids, DaVee says you may need procedures like rubber band ligation, a special procedure to remove hemorrhoids, or surgery to get rid of them.
2. Anal fissures
Anal fissures –– small tears in the anus –– often happen when you are constipated and strain to pass a stool.
With anal fissures, you'll typically see bright red blood when wiping, says DaVee. You might also find drops of blood in the toilet bowl.
Other common symptoms of anal fissures include:
- Pain during and after pooping
- Burning or itching of the anus
- Blood on the outside of your poop
- A visible cut/tear
How to treat it: In most cases, home treatment is enough to heal your fissures. Similarly to treating hemorrhoids, DaVee says this includes:
- Fiber supplements
- Stool softeners
- Drinking enough fluids
- Eating a high-fiber diet
If the fissures aren't healing after this, you can try over-the-counter creams, ointments, or suppositories to help ease inflammation and pain. In more serious cases, surgery can help.
3. Colitis
Colitis is the general term for inflammation of the colon, which can result in both blood when you wipe and blood in the stool, Houghton says. He says some common examples are:
- Ulcerative colitis
- Crohn's disease
- Infectious colitis (due to bacteria or a virus)
- Ischemic colitis
If you have one of these conditions, you'll likely have other significant GI symptoms aside from blood in the stool, such as stomach pain, diarrhea, upset stomach, or weight loss.
How to treat it: Treatment will depend on the condition that is causing the inflammation of your colon. This could be a combination of lifestyle changes, home remedies, prescribed medications, or surgery in severe cases.
For example, treating ulcerative colitis or Crohn's disease usually involves adopting a low-residue diet and taking anti-inflammatory medication.
4. Diverticulosis
Diverticulosis is the condition where small pockets develop in the lining of the colon. "Rarely, one of these pockets can irritate a small blood vessel that passes by and the vessel can bleed, resulting in frequent, large volumes of red blood from the rectum," Houghton says.
This is known as diverticular bleeding. The blood may come with mild abdominal cramping, but it is often painless.
"Diverticular bleeding more commonly presents with larger amounts of blood which coat the stool and can be accompanied by numerous bloody bowel movements," DaVee says. There can be significant blood loss, in which case you should seek medical attention ASAP.
How to treat it: In severe cases with a lot of blood loss, a patient may need IV fluids and blood transfusions, DaVee says. Plus, additional testing and procedures can help identify the direct source of the bleeding, and surgery could be necessary.
In other cases of diverticulosis and to prevent complications like diverticulitis (infection of the pockets), you should follow healthy lifestyle tips such as:
- Eating a high-fiber diet
- Drinking enough water
- Getting daily exercise
5. Rectal prolapse
A rectal prolapse is when the inside lining of the rectum protrudes out –– especially during straining or during a bowel movement, possibly causing blood when wiping, says Houghton. This type of prolapse is most common in older women.
You might see a visible ball of tissue that can range from pink to red color sticking out of the rectum, and it can usually go back up into the rectum on its own or by pressing with a finger, Houghton says.
Rectal prolapse can come with other symptoms such as:
- Pain or pressure in the rectum and anus
- Constipation
- Mucousy discharge in your poop
- Inability to control your bowel movements
- Anal itching
How to treat it: It's important to treat the potential underlying causes of the prolapse, such as chronic diarrhea, constipation, or straining, says DaVee. In severe cases, surgery is necessary to correct the prolapse.
6. Anal fistula
"An anorectal fistula is an abnormal tunnel between two parts of the body such as the rectum and the skin around the anus, which initially starts as an infection of one of the glands around the anus," DaVee says. This can result in small amounts of blood or even pus drainage when you wipe.
Other symptoms of anal fistula include:
- Abscesses in the anus
- Irritation, pain, or swelling of the anus
- Pain while pooping
- Signs of infection such as fever, chills, and fatigue
How to treat it: Surgical procedures including a seton placement are frequently required for treating anorectal fistula, DaVee says. A seton acts as a drain for the fistula and is left in for about six weeks while it heals.
Additionally, if your anal fistula is due to an underlying condition such as Crohn's disease or diverticulitis, it's important to get that under control to prevent future fistula.
7. Colorectal cancer
While colorectal cancer shouldn't be your number one concern if you notice blood when you wipe, it is a possibility. The risk of colorectal cancer is 4% for women and 4.3% for men, making it the third most commonly diagnosed cancer in the US.
"Colorectal cancer may commonly present with blood in the stool as the cancer can become ulcerated and bleed when the stool is passing by," DaVee says.
Other than blood in the stool and when wiping, other symptoms of colorectal cancer are:
- Diarrhea
- Constipation
- Abdominal aching or cramping
- Unexplained weight loss
However, these symptoms do not necessarily indicate you have cancer, as these symptoms are common with many other GI issues. Your doctor can run the necessary tests to determine your diagnosis.
How to treat it: "Treatment of colon cancers depends on the stage and if the cancer has spread to other parts of the body," DaVee says.
He says some treatment options include:
- Specialized colonoscopy resection procedures
- Surgery to remove a section of the colon and surrounding lymph nodes
- Chemotherapy
- Immunotherapy
Insider's takeaway
Seeing blood when you wipe can indicate a variety of problems ranging from benign conditions like hemorrhoids or anal fissures to something more severe, like cancer.
As a general rule of thumb, Houghton says that typically bright red blood that's just on the toilet paper occasionally is likely due to something benign, whereas darker blood, large amounts of blood, or blood in the stool itself are more likely to indicate a serious condition.
Regardless, any instance of blood while wiping or pooping should get evaluated by your doctor.
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