Seeing blood when you wipe after using the bathroom can be alarming. However, there are several potential causes, most of which are not serious. Some common reasons for bleeding when wiping include hemorrhoids, anal fissures, infection, inflammatory bowel disease, cancer, and trauma. Determining the cause involves considering your other symptoms and getting an exam and testing done by your doctor if needed. Treatment depends on the underlying cause but often includes over-the-counter remedies and lifestyle changes. While bleeding with bowel movements should always be evaluated, in most cases, it resolves on its own or with simple treatment.
What Causes Bleeding When I Wipe?
Here are some potential causes of bleeding from the rectum after wiping:
Hemorrhoids
Hemorrhoids are enlarged, swollen blood vessels located in and around the anus and lower rectum. They are very common, affecting nearly 50% of people at some point. Hemorrhoids can be internal (inside the rectum) or external (under the skin around the anus). Bleeding is a common symptom, especially with internal hemorrhoids. This happens when hard stool or constipation causes excessive straining or irritation of the hemorrhoid. The blood is typically bright red. Painless bleeding with a bowel movement is the most common sign of hemorrhoids.
Anal Fissures
Anal fissures are small tears or cracks that form in the lining of the anus. Constipation and straining with hard stools is the most common cause. A fissure can cause sharp rectal pain and bleeding, especially during and after a bowel movement. The blood is also usually bright red but may be mixed with stool.
Infection
Infections from bacteria, viruses, or parasites can infect the lower digestive tract and rectum, leading to inflammation, irritation, and bleeding. Common examples include sexually transmitted infections like herpes, chlamydia, and gonorrhea. Viral infections from HPV or HIV can also cause rectal bleeding. Parasites like pinworms are another possibility.
Inflammatory Bowel Disease (IBD)
Chronic conditions like Crohn’s disease or ulcerative colitis that cause inflammation and ulcers in the digestive tract may lead to rectal bleeding if the rectum is affected. IBD also typically causes diarrhea, abdominal pain, and weight loss.
Rectal Cancer
While rare in younger adults, rectal cancer incidence increases after age 50. Rectal cancer can initially cause minor rectal bleeding due to the friable tumor tissue. It’s important to get checked out to rule out cancer if you have persistent bleeding.
Anal Tears (Trauma)
Vigorous wiping, constipation, large or hard stools, diarrhea, and anal sex can result in tears of the delicate anal tissues. This can lead to pain and bleeding from the delicate rectal veins.
When to See a Doctor
You should make an appointment with your doctor if you notice any of the following:
– Bleeding that persists longer than 1-2 weeks
– Frequent bleeding episodes
– Bleeding accompanied by pain, itching, or lump/mass
– Bleeding associated with other changes like abdominal pain, weight loss, fever
– Bleeding that is significant or heavy like a menstrual period
– Bleeding that makes you dizzy or lightheaded
Rectal bleeding in children or older adults also needs prompt medical attention. Bleeding along with diarrhea or constipation points to an inflammatory or infectious cause.
Doctors and Tests
To evaluate the cause of rectal bleeding, the doctor will begin with questions on your medical history and current symptoms. Significant or prolonged bleeding may require blood tests to check for anemia.
The physical exam will include a visual inspection of the anus to look for hemorrhoids, fissures, warts, or abnormal growths. A digital rectal exam allows the doctor to feel for masses, enlarged prostate, stool, or sources of bleeding.
Further testing may include:
- Anoscopy – examines the anal canal with a short lighted tube
- Sigmoidoscopy or colonoscopy – views the rectum and colon with a flexible lighted scope
- Barium enema – x-ray of the colon and rectum after barium injection
- CT colonography – cross-sectional CT scan images of the colon
- Biopsy – takes a tissue sample to test for cancer, infection, or inflammation
- Stool culture or test – checks for blood or infectious organisms
Treatments and Home Remedies
Treatment depends on identifying the underlying cause of the bleeding. However, some general treatments include:
Improving bowel habits
Straining from constipation or diarrhea can worsen many causes of bleeding. Eating more fiber, exercising, and drinking fluids can improve regularity. Over-the-counter stool softeners or laxatives may help constipation. Anti-diarrheal medicines can slow diarrhea if needed. Avoid straining when using the bathroom.
Keeping the area clean
Gently wash the anal area after a bowel movement. Soaking in a sitz bath of warm water may help hemorrhoids and fissures. Use soft toilet paper, cotton pads, or baby wipes instead of rough toilet paper. Change underwear and pads frequently with heavy bleeding.
Using over-the-counter remedies
Non-prescription hemorrhoid creams, ointments, suppositories, or wipes can relieve swelling, burning, and itching. Witch hazel pads can reduce irritation. Analgesics like acetaminophen help relieve pain.
Trying prescription medications
If over-the-counter remedies aren’t helping, your doctor may prescribe hydrocortisone cream, hemorrhoid suppositories, stool softeners, antibiotics for infection, 5-ASAs for inflammatory bowel disease, or other medicines based on the cause.
Minimally invasive procedures
Procedures like rubber band ligation or infrared coagulation can remove internal hemorrhoids. Anal dilators may help reduce spasms or strictures.
Surgery
Surgery may be required for larger hemorrhoids, extensive anal fissures, fistulas, abscesses, or tumors. Common procedures include a hemorrhoidectomy to remove hemorrhoids or lateral internal sphincterotomy for anal fissures. Surgery carries risks of bleeding, infection, and scarring.
Prevention
You can take some measures to help prevent rectal bleeding or keep it from worsening:
- Consume more fiber from fruits, vegetables, whole grains, beans, etc.
- Drink plenty of water daily.
- Exercise to reduce straining and constipation.
- Do not delay going to the bathroom.
- Avoid prolonged sitting on the toilet.
- Avoid straining to pass stools.
- Do not use dry or rough toilet paper.
- Clean the anus gently after a bowel movement.
- Avoid vigorous wiping and scrubbing.
- Use wet wipes after a bowel movement.
- Take sitz baths to relieve irritated hemorrhoids or fissures.
- Treat constipation or diarrhea promptly.
- Practice safe sex with condoms to avoid STIs.
When to Seek Emergency Care
You need emergency medical care if you have:
– Heavy bleeding that soaks through a pad or underwear
– Bleeding that does not stop
– Lightheadedness, dizziness or feeling faint
– Rectal pain that becomes severe or excruciating
Go to an emergency room or call 911 if you develop these warning signs of significant blood loss.
Conclusion
Noticing some blood when wiping does not necessarily indicate a serious problem. However, persistent or heavy bleeding should be evaluated. Common causes include hemorrhoids, anal fissures, infection, inflammatory bowel disease, tumors, and trauma. See your doctor for bleeding that lasts more than 1-2 weeks or happens frequently. An exam and testing can determine the cause. Treatment options range from over-the-counter remedies and prescription medications to minimally invasive procedures or surgery in some cases. Addressing the underlying cause and making lifestyle changes can often resolve minor rectal bleeding. However, significant or prolonged bleeding requires prompt medical treatment to identify and stop the source.
| Cause | Symptoms | Risk Factors | Diagnosis | Treatment |
|---|---|---|---|---|
| Hemorrhoids | Painless bleeding, prolapse, swelling, itching | Constipation, straining, pregnancy, aging | Visual inspection, anoscopy | OTC remedies, prescription meds, procedures, surgery |
| Anal Fissures | Painful tearing, bright red blood, spasm | Constipation, diarrhea, straining, trauma | Visual inspection, anoscopy | Soften stools, sitz baths, dilation, surgery |
| Infection | Itching, pain, pus/discharge, diarrhea | STDs, poor hygiene, parasites | Blood tests, stool culture | Antibiotics, antivirals |
| IBD | Abdominal pain, diarrhea, weight loss | Genetics, autoimmune disorder | Endoscopy, biopsy, CT scan | Aminosalicylates, steroids, immunosuppressants |
| Cancer | Bleeding, change in stools, weight loss | Age, family history, radiation | Colonoscopy, biopsy | Surgery, radiation, chemotherapy |
| Trauma | Bleeding, pain with bowel movements | Constipation, straining, anal sex | Visual inspection | Stool softeners, topical creams |
In most cases, minor rectal bleeding is not an emergency. Prompt evaluation and treatment can improve many causes and provide relief from discomfort. Seek medical advice to determine the cause and appropriate treatment based on your symptoms.
