Blood in poop but not on toilet paper

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.

Non-urgent advice: See a GP if:

• your child has blood in their poo
• you've 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've been more tired than usual
• you've lost weight for no reason

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

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

You can call 111 or get help from 111 online.

Immediate action required: 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

Find your nearest A&E

What happens at the GP appointment

If you have bleeding from your bottom, a GP will check what's causing it.

They might:

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

Important: Bowel cancer risk

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 a GP if you're worried.

Possible causes of bright red rectal bleeding.SymptomsPossible causesBright red blood and pain when pooing, itchy bottom, lumpsPiles (haemorrhoids)Bright red blood and pain when pooing – often after constipationA small tear in your anus (anal fissure)Bleeding with or without lumps, itching or painSexually transmitted infections (STIs) like genital warts, damage from anal sexBright red blood without painSide effect of blood-thinning medicine (anticoagulants) like warfarin or aspirin, broken blood vessels in the gut (angiodysplasia)

Poo can look like it's mixed with blood if you've 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.

Possible causes of slime or blood in your poo.SymptomsPossible causesBlood and yellow slime when pooing, irritated anus, non stop bottom painAnal fistulaBloody diarrhoea with clear slime, feeling and being sickTummy bug (gastroenteritis)Bloody diarrhoea, tummy cramps and pain, feeling bloatedAn inflammatory bowel disease (IBD) like ulcerative colitis or Crohn's diseaseBlood in pooBleeding in the anus, bowel or lower gut from injury or another problemBlood in poo, change in pooing habits (like looser poo, diarrhoea or constipation), slime with pooBowel polyps, early signs of bowel cancer

Poo can look very dark or black if you:

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

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

Possible causes of very dark or black blood coming from your bottom.SymptomsPossible causesDark or black pooBleeding in the stomach or gut – can be from injury or a side effect of blood-thinning medicine (anticoagulants) like warfarin or aspirinDark blood or poo with tummy pain or crampsStomach ulcer, diverticular disease and diverticulitisDark blood without painBlood-thinning medicine like warfarin or aspirin, angiodysplasia (broken blood vessels in the gut)

It is common to see blood on the toilet paper, around the stool (poo), or in the toilet after a bowel motion. This is known as rectal bleeding and it can occur for many reasons. Most of the time rectal bleeding is not a sign of a serious illness, but it is important to see your doctor.

What is rectal bleeding?

Rectal bleeding means bleeding from your back passage (anus) when you go to the toilet and pass faeces (poo).

When should I go to the emergency department?

You should always have bleeding from the anus checked out by a doctor as it could be a sign of something serious.

Seek urgent medical attention if:

• the bleeding is very heavy
• you have signs of shock like rapid, shallow breathing, dizziness, nausea or confusion
• you have black or dark red poos
• your vomit contains blood or what looks like coffee grounds
• you faint
• you have a severe pain in your rectum
• you have heavy rectal bleeding along with bad stomach pains, a fever, weakness, nausea or you cannot have a bowel motion (poo)

FIND A HEALTH SERVICE — Our Service Finder can help you find doctors, pharmacies, hospitals and other health services.

What are the symptoms of rectal bleeding?

The colour of your blood can indicate where in the gastrointestinal system the bleeding is coming from. For example, fresh, bright red blood can show the bleeding is coming from lower in the bowel, nearer to the back passage, which may be a sign of haemorrhoids or fissures.

Bleeding in your large intestine (colon) may be fresh red or a darker red and mixed in with your faeces. One of the causes can be polyps, which are growths on the intestinal wall. Polyps are usually harmless, but some types can turn into bowel cancer.

Faeces that are black, like tar, and that have a very bad smell may suggest a problem higher up in the gastrointestinal system — for example, in the stomach or duodenum — such as a bleeding ulcer.

CHECK YOUR SYMPTOMS — Use our blood in stool and rectal problems Symptom Checker and find out if you need to seek medical help.

What causes rectal bleeding?

There are lots of possible causes for rectal bleeding. Common causes include:

• hard stools (poo)
• haemorrhoids (also known as piles), which are often associated with constipation
• anal fissure (a small tear in the opening of the anus) or fistula (a small channel that develops between the anus and skin)

Less common causes include:

When should I see a doctor?

Make an appointment to see your doctor if you have rectal bleeding that lasts more than 1 or 2 days, or earlier if the bleeding worries you.

Most people who have rectal bleeding don't have cancer or another serious illness, but it's important to have it checked out.

How is rectal bleeding diagnosed?

The tests for rectal bleeding depend on your age, symptoms and medical history. Your doctor will talk to you and examine you, and might want to look inside your rectum and bowel. You might also need tests, including:

• Anoscopy — this is when a small instrument is inserted into your anus to allow your doctor to have a clearer view.
• Sigmoidoscopy — this is a procedure to look inside of the left, lower part of your colon (large bowel) using a flexible telescope.
• Colonoscopy — a flexible tube is inserted into the anus to view the inside of the large bowel (the colon).

Some of these tests are done under sedation and anaesthetic. Ask your doctor for more information.

How is rectal bleeding treated?

Treatment will depend on what is causing the rectal bleeding.

For some problems, the treatment could be to make changes to your lifestyle or diet.

Haemorrhoids often settle down quickly after a few days and do not require any special treatment. If your haemorrhoids are causing you pain or discomfort, ask your doctor or chemist about medicated creams or ointments that may ease your symptoms.

If your haemorrhoids keep coming back, you can talk to your doctor about the possibility of surgical treatment.

Treatment for anal fissures can involve botox injections or surgery.

Can I manage or prevent rectal bleeding?

If you have rectal bleeding, there are a number of things you can do to help manage the condition.

If you have constipation causing haemorrhoids, you can help ease it by:

• drinking plenty of water, unless you have an existing medical condition that means this is not possible
• eating fibre-rich foods, such as bran cereals, fruit, vegetables and wholegrain bread
• avoiding processed foods, such as white bread and cheese
• keeping active and mobile to reduce the risk of getting constipated
• going to the toilet when you have the urge

If your doctor has confirmed that you have an anal fissure, you can ease the discomfort by:

• very carefully wiping the anal area after going to the toilet and using soft, moist toilet paper or baby wipes, rather than dry toilet paper
• patting the area around your bottom rather than rubbing it
• having warm baths a few times a day
• seeing your pharmacist for topical creams to reduce the pain
• making sure you eat a healthy diet with plenty of fibre, and drinking plenty of fluids to keep your stool as soft and well-formed as possible
• trying not to strain when passing a stool

Do not apply creams and lotions to the area that were not prescribed by your doctor or pharmacist because this can cause more trauma.

Suspicion of deliberate harm

If there is any suspicion that rectal bleeding is not the result of an anal condition but is due to an injury inflicted on purpose, you should seek help from a healthcare professional as soon as possible. This could be from a nurse or doctor at a hospital emergency department, or a doctor’s surgery, or a health visitor or school nurse.

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