Rectal Bleeding

In brief: Rectal bleeding means blood is passed from the anus; it has many possible causes and should not be assigned to hemorrhoids without appropriate assessment.

Use in hemorrhoids

Internal hemorrhoids can cause bright red bleeding with bowel movements, often without pain. External hemorrhoids more often cause swelling or pain than bleeding, although irritated skin or a thrombosed external hemorrhoid can bleed. Appearance alone cannot confirm the source. [1]

Assessment considers duration, amount, stool changes, abdominal symptoms, weight loss, anemia symptoms, medicines, age, family history, inspection, and anorectal examination. Anoscopy may identify internal hemorrhoids, but persistent or unexplained bleeding can require evaluation of the rectum or colon. [2]

Clinical detail

Small streaks and large-volume bleeding are not equivalent, but neither should be diagnosed from color alone. Heavy or continuing blood loss, fainting, dizziness, marked weakness, fever, severe pain, black stool, or systemic illness needs urgent assessment. A hemorrhoid found on examination does not exclude another simultaneous source.