Rectal bleeding: causes and which doctor to see

For rectal bleeding you can first see: General Surgery or Internal Medicine or Gastroenterology. In large hospitals, the Gastroenterology and Colorectal Surgery unit also deals with this. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: bright red blood on toilet paper or in the toilet bowl; dark red blood mixed in with stool; black, sticky, bad-smelling stools; pain or itching in the back passage; tiredness and paleness (with long-term bleeding). Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: haemorrhoids (piles); anal fissure; bowel polyps; diverticular bleeding; ulcerative colitis and Crohn’s disease; bowel (colon and rectal) cancer; bleeding from a stomach or duodenal ulcer (black stools). Only a doctor’s examination can determine the exact cause.

Bleeding from haemorrhoids and fissures usually stops within days with softer stools and the treatments the doctor recommends. Polyps can be removed during colonoscopy. Treatment depends on the source of bleeding.

It is more common in: people with constipation; pregnant women; people over 45; people with a family history of bowel cancer or polyps; people taking blood thinners.

An examination of the back passage and rectoscopy are done. Blood count and iron tests are checked; if there is risk, colonoscopy is recommended. Black stools need endoscopy.

Eat high-fibre food, drink water and strain less. Do not miss bowel cancer screening appropriate for your age.

Most of the time it is due to haemorrhoids or a fissure; but because it can also be a sign of bowel cancer, examination and, if needed, colonoscopy are recommended, especially over 45.

They can be a sign of bleeding from the stomach or duodenum; iron tablets also darken stools. Sticky, tar-like black stools need urgent assessment.

If the answer to any of these questions is yes, call 112 without delay: “Is there a lot of blood, or dizziness, a feeling of fainting or palpitations?” “Are there black, tarry stools with vomiting?” “With the bleeding, is there severe abdominal pain and fever?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: soon, if you have rectal bleeding for the first time; you are over 45 or there is bowel cancer in the family; your bowel habits have changed or you are losing weight; the bleeding keeps coming back.