Rectal Bleeding

Rectal bleeding should never be ignored, whether it's fresh blood or blood mixed in stool.

A colonoscopy helps identify the source, from benign conditions to serious disease.

20+ years of experience

5000+ scopes performed

Fellowship-trained colorectal surgeon

Medisave & Insurance Claimable

What is Rectal Bleeding?

Rectal bleeding refers to any blood that passes from the anus, whether it is visible in the stool, on toilet paper, or in the toilet bowl. Bleeding can range from mild to severe, and may appear suddenly, or develop gradually over time. While it is often caused by minor conditions such as haemorrhoids , or small tears in the anal lining, it can also signal more serious gastrointestinal problems that require medical evaluation.

Bleeding may originate anywhere along the lower digestive tract, from the rectum and anus to the colon. It is not always obvious where the source is. That is why it is essential not to ignore even small amounts of blood, especially if they occur repeatedly or are accompanied by other symptoms.

What does Rectal Bleeding look like?

The appearance of rectal bleeding can vary based on the source of the problem. Observing the colour, and pattern can give helpful clues. This includes:

Bright red colour – usually indicates bleeding from the rectum, or lower colon, commonly due to haemorrhoids, fissures or rectal ulcers.
Blood mixed with stool – could point to inflammation, or growths within the colon or rectum.
Blood on toilet paper or dripping into the bowl – often seen with haemorrhoids or anal fissures (link to anal fissures page).
Dark red or maroon blood – may suggest bleeding higher up in the colon.
Black, tarry stools – this is called melena, which typically indicates bleeding from the upper gastrointestinal tract, such as the stomach or small intestine.

What causes Rectal Bleeding?

There are many possible causes of rectal bleeding. While some are benign, and easily treatable, others may need prompt medical intervention. Some of the potential causes include:

Anal fissures – small tears in the lining of the the anus, often caused by straining during passage of hard stools or diarrhoea
Colorectal polyps or cancer – polyps are growths that can bleed, and some may become cancerous if it is not removed. Cancerous growths are often friable and can give rise to visible blood in the stools
Diverticular disease – bleeding may occur when blood vessels at the base of the small pouches in the colon (known as diverticuli) rupture and lead to profuse bleeding
Haemorrhoids – swollen veins in the lining of the anus that can bleed during bowel movements.
Inflammatory bowel disease (IBD) – conditions like ulcerative colitis, or Crohn’s disease can lead to bleeding from inflamed intestinal tissue.
Infections – certain gastrointestinal infections can cause inflammation and blood in the stool.
Rectal ulcers – sores in the rectum may bleed intermittently or continuously.

If you are experiencing the symptoms,

consult a medical professional immediately.

Schedule an appointment with Dr Aaron Poh.

book an appointment

What are the warning signs of Rectal Bleeding that require medical attention?

While occasional spotting may not always be a cause for alarm, certain signs should never be ignored. Seek medical attention promptly if you experience:

Bleeding accompanied by abdominal pain, fever, or weight loss
Bleeding accompanied by a significant change in bowel habits, be it the frequency of passing motion or the consistency of the stools
Bleeding that recurs frequently, or increases over time
Dark, or tarry stools, which may indicate internal bleeding
Dizziness, or signs of anaemia such as fatigue, shortness of breath, and pale skin
Large amounts of blood, or ongoing bleeding
A family, or personal history of colorectal cancer, or polyps

Who is at risk of Rectal Bleeding?

Rectal bleeding can affect anyone, but certain individuals may be more prone due to age, lifestyle, or underlying health conditions. These risk factors may include:

Older adults — as we age, the walls of the colon, and rectum may weaken, making them more vulnerable to conditions like diverticulosis, and vascular fragility. Polyps and other growths also become more common, increasing the likelihood of bleeding.
People with chronic constipation — straining to pass hard stools put pressure on the anal, and rectal blood vessels. This can cause haemorrhoids, or small tears in the anal lining, resulting in anal fissures. Both conditions are common sources of bleeding.
Individuals with inflammatory bowel disease (IBD) — conditions like Crohn’s disease, and ulcerative colitis cause chronic inflammation in the gut lining. This irritation can lead to ulcers or raw, fragile tissue that bleeds more easily, especially during flare-ups.
Patients on blood thinners — medications such as aspirin, warfarin, or other anticoagulants reduce the blood’s ability to clot. This means that even small injuries in the gastrointestinal tract may lead to prolonged, or more noticeable bleeding.
Those with a family history of colorectal cancer — genetic predisposition can increase the risk of developing polyps, or colorectal cancer, both of which may bleed, even in the early stages when other symptoms are absent.
Pregnant or postpartum women — hormonal changes during pregnancy, along with increased abdominal pressure, and straining during childbirth, can lead to the development of haemorrhoids. Constipation can lead to fissures, making rectal bleeding more likely.

Schedule Your Appointment with Dr Aaron Poh.

How is Rectal Bleeding diagnosed?

When it comes to diagnosing rectal bleeding, Dr Aaron Poh focuses on identifying the exact causes of bleeding. This entails a combination of detailed consultation, clinical examination, and appropriate treatment as per below:

Medical history and symptom review – Dr Aaron Poh will ask about the frequency, amount, and appearance of the bleeding. He will also ask about any associated symptoms like pain, weight loss or changes in bowel habits.
Physical examination – this often includes a gentle inspection of the anal area, and a digital rectal examination and a gentle proctoscopy to detect fissures, haemorrhoids or masses.
Flexible sigmoidoscopy or colonoscopy – depending on your symptoms, and risk factors, the doctor may recommend a scope test to visualise the rectum, and colon. This allows for direct assessment, biopsy of suspicious areas or removal of polyps.
Laboratory tests – blood tests may be ordered to check for anaemia, or signs of infection. A stool test may also be used to detect hidden blood or infections.

How is Rectal Bleeding treated?

Treatment depends on the underlying causes, the severity of bleeding, and your overall health. Many minor causes can be managed conservatively, while more serious conditions may need medical, or surgical intervention.

Conservative treatments

Topical creams or suppositories – to reduce swelling, and discomfort from haemorrhoids, or fissures.
Dietary changes – a high-fibre diet, and increased hydration can help ease constipation, and prevent recurrence.
Medications – to treat inflammation, infections, or regulate bowel habits.

Endoscopic and surgical treatments

Polyp removal – the procedure is often performed during a colonoscopy, and is done to prevent progression to cancer.
Treatment of diverticular bleeding – this may include observation, radiologically-guided embolization of the bleeding vessel , or surgery if the bleeding is persistent.
Management of colorectal cancer – often involves a multidisciplinary approach, which may include surgery.

Summary

Rectal bleeding may be alarming, but it is not something you need to face alone. While the cause is often minor, it can sometimes signal a more serious condition that requires medical attention. The key is not to ignore the signs, especially if the bleeding is persistent, recurrent or accompanied by other symptoms.

Dr Aaron Poh understands how personal, and worrying these symptoms can be. At Alpine Surgical Practice, we believe in providing a compassionate and discreet approach to diagnosis and care, helping you find clarity and relief with the least discomfort possible.

If you have noticed blood in your stool, or on toilet paper, do not wait. Book a consultation today for a thorough evaluation, and personalised treatment plan that puts your health, and peace of mind first.

Frequently Asked Questions (FAQs)

Is rectal bleeding painful?

It depends on the cause. Haemorrhoids, and anal fissures can cause pain during bowel movements, while bleeding from polyps or diverticula may be painless.

Can babies or children experience rectal bleeding?

Yes, causes in children include constipation, anal fissures, or infections. Regardless of the causes, any rectal bleeding in young children should be evaluated by a doctor immediately.

Can certain foods cause bloody stool?

Foods like beetroot or red gelatin can mimic blood in stool, but they do not cause bleeding. But if you are in any doubt, always seek medical advice.

Is rectal bleeding always serious?

Not always. Many cases are minor, and self-limiting. However, bleeding can also signal serious conditions like colorectal cancer. It is important to be assessed, especially if symptoms recur, or worsen.

What if I only see blood once? Should I still see a doctor?

Yes, even a one-time occurrence may warrant investigation, especially if you are over 40 years old, have other symptoms, or have a family history of bowel disease.

Can stress cause rectal bleeding?

While stress does not directly cause bleeding, it may worsen digestive issues like constipation, or irritable bowel syndrome (IBS), which can contribute to minor bleeding.

How do I know if it is haemorrhoids or something more serious?

Only a medical examination can confirm the cause. Symptoms like pain, itching, and bleeding may overlap across conditions. That is why seeking professional evaluation is important.

Will the bleeding stop on its own?

Mild cases may be resolved with rest and dietary adjustments. However, ongoing or heavy bleeding requires prompt care.

Meet Our Doctor

DR AARON POH

Dr Aaron Poh is a fully accredited General Surgeon with dual subspecialties in Colorectal Surgery and Trauma Surgery, recognised by Singapore’s Specialist Accreditation Board and Ministry of Health. He is the Medical Director of Alpine Surgical Practice, with clinics located at Mount Elizabeth Hospital, Parkway East Hospital, and Farrer Park Hospitals.

Dr Aaron Poh has extensive experience, having performed over 5,000 endoscopic procedures. He is a strong advocate for early detection through colonoscopy, particularly for individuals at risk of colorectal cancer. His expertise includes advanced endoscopic techniques such as Endoscopic Mucosal Resection (EMR) for complex polyps and colonic stenting for obstructed cancers, which help patients avoid major emergency surgery.

When surgery is required, he specialises in minimally invasive laparoscopic colorectal cancer surgery, offering patients faster recovery with less pain and scarring. In addition to cancer care, he manages a wide range of anal conditions including haemorrhoids, fistulas, fissures, and abscesses, providing comprehensive colorectal treatment.