Bleeding from the bottom (rectal bleeding)Overview

A small amount of one-off bleeding from the bottom is not usually a serious problem. But a GP can check.

Check if you're bleeding from the bottom

You might be bleeding from the bottom if you have:

• blood on your toilet paper
• red streaks on the outside of your poo
• pink water in the toilet bowl
• blood in your poo or bloody diarrhoea
• very dark, smelly poo (this can be blood mixed in poo)

A small amount of one-off bleeding can often go away on its own without needing treatment.

See a GP if:

• your child has blood in their poo
• you have had blood in your poo for 3 weeks
• your poo has been softer, thinner or longer than normal for 3 weeks
• you're in a lot of pain around the bottom
• you have a pain or lump in your tummy
• you have been more tired than usual
• you have lost weight for no reason

Get advice from 111 now if:

• your poo is black or dark red
• you have bloody diarrhoea for no obvious reason

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

Get an urgent GP appointment

A GP may be able to treat you.

Ask your GP practice for an urgent appointment.

Go to A&E or call 999 if:

• you're bleeding non-stop
• there's a lot of blood – for example, the toilet water turns red or you see large blood clots

What happens at your GP appointment

The GP will check what's causing your symptoms.

They might:

• check your bottom (rectum) with a gloved finger
• ask for a sample of poo for testing
• refer you to a specialist for tests

Important

Bleeding from the bottom is sometimes a sign of bowel cancer.

This is easier to treat if it's found early, so it's important to get it checked.

Common causes of bleeding from the bottom

If you have other symptoms, this might give you an idea of the cause.

Do not self-diagnose – see your GP if you're worried.

Bright red blood on toilet paper, streaks on poo, pink toilet water

Symptoms	Possible causes
Bright red blood and pain when pooing, itchy bottom, lumps	piles (haemorrhoids)
Bright red blood and pain when pooing – often after constipation	a small tear in your anus (anal fissure)
Bleeding with or without lumps, itching or pain	sexually transmitted infections (STIs) like genital warts, damage from anal sex
Bright red blood without pain	side effect of blood-thinning medication like warfarin or aspirin, broken blood vessels in the gut (angiodysplasia)

Blood in poo or blood with slime

Poo can look like it's mixed with blood if you have eaten a lot of red or purple foods like tomatoes and beetroot.

But it's sometimes a sign of something else. A GP can check if you're worried.

Symptoms	Possible causes
Blood and yellow slime when pooing, irritated anus, non-stop bottom pain	anal fistula
Bloody diarrhoea with clear slime, feeling and being sick	tummy bug (gastroenteritis)
Bloody diarrhoea, tummy cramps and pain, feeling bloated	an inflammatory bowel disease (IBD) like ulcerative colitis or Crohn's disease
Blood in poo	bleeding in the anus, bowel or lower gut (gastrointestinal tract) from injury or another problem
Blood in poo, change in pooing habits (like looser poo, diarrhoea or constipation), slime with poo	bowel polyps, early signs of bowel cancer

Very dark or black blood or poo

Poo can look very dark or black if you:

• take iron tablets
• eat a lot of dark foods like licorice and blueberries

But it's sometimes a sign of something else. A GP can do a test to check this if you're worried.

Symptoms	Possible causes
Dark or black poo	bleeding in the stomach or gut (gastrointestinal tract) – can be from injury or a side effect of blood-thinning medication like warfarin or aspirin
Dark blood or poo with tummy pain or cramps	stomach ulcer, diverticular disease and diverticulitis
Dark blood without pain	blood-thinning medication like warfarin or aspirin, angiodysplasia (broken blood vessels in the gut)