Do I Need to Worry About Blood in the Stool? (Rectal Bleeding)

When anyone notices blood in the toilet, it brings panic and fear in most people’s minds. It is rightly so. But we need to understand that most of them do not suffer from the dreaded colorectal cancer.

What are the causes of rectal bleeding? What are its likely symptoms?

1. Piles (hemorrhoids): Painless, recurrent, may be associated with constipation, usually self-limiting, lasting a few days, like a splash on a pan (separate blog)
2. Fissure: Painful, few drops, few days
3. Diverticular: Painless, large quantity, self-limiting
4. Colorectal cancer: Few mls, persistent, associated with other symptoms (separate blog), mixed with stool
5. Inflammatory bowel disease: Long standing,  loose motion, slime/jelly
6. Infective colitis: Few days of loose motion and vomiting, settles when infection subsides

When should one worry about rectal bleeding?

If it is happening for the first time in people above the age of 50 years, then you are likely to need colonoscopy to rule out colorectal cancer. Again, it is only to rule out. Also, the incidence of colorectal cancer is low in India. But a colonoscopy is almost mandatory for this group of patients.

If there is family history of cancer, then irrespective of age, a colonoscopy needs to be conducted to rule out colorectal cancer.

When there are symptoms of colorectal cancer or inflammatory bowel disease. (Both explained in separate blogs).

What is the common cause of rectal bleeding? What are its features?

Most of the times, rectal bleeding occurs due to piles (hemorrhoids). When one thinks of the following facts, it puts rectal bleeding in new light:

1. Everyone is born with piles and dies with piles. It’s a normal part of the body.
2. They will never cause cancer or turn into one.
3. Piles almost never cause pain.
4. Most times, it is self-limiting.
5. It is usually aggravated by constipation.