- If bleeding on wiping coincides with constipation, you may have anal fissures.
- Hemorrhoids can also cause rectal bleeding, irritation, and pain in the anus.
- If the blood loss is significant, you should suspect diverticulitis and see a doctor as soon as possible.
It’s alarming to notice blood on the toilet paper when wiping after pooping, especially if this is your first time. You may notice blood on the toilet paper, drops of blood in the toilet, or blood mixed with your feces.
Causes of blood when wiping range from benign to more serious. It’s important to note any other symptoms that are presenting with the bleeding and talk to your doctor to determine the cause.
Here are seven possible reasons blood appears when mopping.
One of the most common causes of blood showing up on wiping is hemorrhoids — swollen veins under the skin just inside or outside the rectum, says Dr. Jesse P. Houghton, senior medical director for gastroenterology at SOMC Gastroenterology Associates.
You may see bright red blood on toilet paper or have drops of blood in the toilet after a bowel movement, Houghton says. Aside from bleeding, you may also experience symptoms like pain, swelling, itching, and irritation in the area.
How to treat it: Treatment depends on the severity of your hemorrhoids. In many cases, making minor changes at home can help, says Dr. Roy Tomas DaVee, Gastroenterologist UTHealth Houston and Memorial Hermann.
DaVee says some of these include:
- fiber supplements
- stool softener
- Drink lots of fluids
- Eat a high-fiber diet with lots of fruits and vegetables
- Spend as little time on the toilet as possible to prevent hemorrhoids from enlarging or protruding
However, for larger, more severe hemorrhoids, DaVee says you may need procedures like a rubber band ligation, a special procedure to remove hemorrhoids, or surgery to get rid of them.
2. Anal fissures
Anal fissures — small tears in the anus — are common when you’re constipated and straining to pass a bowel movement.
Anal fissures usually show bright red blood when they are wiped, says DaVee. You may also find drops of blood in the toilet bowl.
Other common symptoms of anal fissures include:
- Pain during and after pooping
- Burning or itching of the anus
- Blood on the outside of your poop
- A visible cut/tear
How to treat it: In most cases, at-home treatment is enough to heal your fissures. Similar to treating hemorrhoids, DaVee says this involves:
- fiber supplements
- stool softener
- Consume enough liquid
- Eat a high-fiber diet
If the fissures don’t heal afterward, you can try over-the-counter creams, ointments, or suppositories to reduce inflammation and pain. In more severe cases, surgery can help.
Colitis is the general term for inflammation of the colon, which can result in blood on wiping as well as blood in the stool, Houghton says. He says some common examples are:
- ulcerative colitis
- Crohn’s disease
- Infectious colitis (bacterial or viral)
- Ischemic colitis
If you have any of these conditions, you are likely to have other significant GI symptoms in addition to blood in your stools, such as abdominal pain, diarrhea, an upset stomach, or weight loss.
How to treat it: Treatment depends on the condition causing your colon to become inflamed. This can be a combination of lifestyle changes, home remedies, prescribed medications, or surgery in severe cases.
For example, treatment for ulcerative colitis or Crohn’s disease usually involves eating a low-residue diet and taking anti-inflammatory drugs.
Diverticulosis is the condition in which small pockets develop in the lining of the large intestine. “Rarely, one of these pockets can irritate a passing small blood vessel and bleed the vessel, resulting in frequent, large amounts of red blood from the rectum,” says Houghton.
This is called a diverticular hemorrhage. The blood may come with mild abdominal cramps but is often painless.
“Diverticulum bleeding is more common with larger amounts of blood covering the stool and can be accompanied by numerous bloody stools,” says DaVee. Significant blood loss can occur, in which case you should see a doctor as soon as possible.
How to treat it: In severe cases with a lot of blood loss, a patient may need IV fluids and blood transfusions, DaVee says. Also, additional tests and procedures can help identify the direct source of the bleeding, and surgery may be needed.
In other cases of diverticulosis, and to avoid complications like diverticulitis (pocket infection), you should follow healthy lifestyle tips such as:
5. Rectal prolapse
A rectal prolapse is when the inner lining of the rectum protrudes — especially during straining or during a bowel movement, potentially causing blood when wiping, Houghton says. This type of prolapse is most common in older women.
You may see a visible ball of tissue, which can range from pink to red, sticking out of the rectum, and it can usually go back into the rectum on its own or by pushing with a finger, Houghton says.
Rectal prolapse can be accompanied by other symptoms such as:
- Pain or pressure in the rectum and anus
- Slimy discharge in your stool
- Inability to control your bowel movements
- Anal itch
How to treat it: It’s important to treat the possible underlying causes of the prolapse, such as chronic diarrhea, constipation, or overexertion, says DaVee. In severe cases, surgery is necessary to correct the prolapse.
6. Anal fistula
“An anorectal fistula is an abnormal tunnel between two parts of the body, such as the rectum and the skin around the anus, that initially begins as an infection of one of the glands around the anus,” says DaVee. This can result in small amounts of blood or even discharge of pus when wiping.
Other symptoms of an anal fistula include:
- abscesses in the anus
- irritation, pain or swelling of the anus
- pain when pooping
- Signs of infection such as fever, chills and tiredness
How to treat it: Surgical procedures, including a seton placement, are often required to treat anorectal fistula, DaVee says. A seton serves as drainage for the fistula and is left in place for about six weeks while it heals.
Additionally, if your anal fistula is due to an underlying condition, such as Crohn’s disease or diverticulitis, it’s important to get it under control to prevent future fistulas.
7. Colon Cancer
While colon cancer shouldn’t be your biggest concern if you notice blood when wiping, it’s a possibility. The risk of colorectal cancer is 4% for women and 4.3% for men, making it the third most commonly diagnosed cancer in the United States.
“Colon cancer can often present with blood in the stool because the cancer can ulcerate and bleed as the stool passes,” says DaVee.
In addition to blood in the stool and when wiping, other symptoms of colon cancer include:
- abdominal pain or cramps
- Unexplained weight loss
However, these symptoms do not necessarily indicate that you have cancer, as these symptoms are common with many other GI problems. Your doctor can perform the necessary tests to make your diagnosis.
How to treat it: “Treatment for colon cancer depends on the stage and whether the cancer has spread to other parts of the body,” says DaVee.
He says some treatment options include:
- Specialized colonoscopy resection procedures
- Surgery to remove a section of the colon and surrounding lymph nodes
If you see blood when wiping, it can indicate a variety of problems, ranging from benign conditions like hemorrhoids or anal fissures to more serious conditions like cancer.
As a general rule of thumb, Houghton says that typically bright red blood that’s only occasionally on the toilet paper is likely due to something benign, while darker blood, large amounts of blood, or blood in the stool itself are more likely to indicate a serious condition.
Regardless, any case of blood from wiping or pooping should be checked out by your doctor.