Sometimes people see blood on the paper after wiping. Hemorrhoids are the most common reason, but rectal bleeding may also indicate a serious gastrointestinal condition that needs medical attention.

A few occasional drops or streaks of blood when wiping are not usually worrying.

Approximately 13–34% of people experience rectum bleeding.

That said, different shades of blood may indicate bleeding from different parts of the digestive system.

  • Bright red blood in the stool may indicate bleeding in the lower colon or rectum.
  • Darker red blood may be a sign of bleeding in the small bowel or upper colon.
  • Very dark or black-red blood often means there is bleeding in the stomach or other organs of the digestive system.

This article reviews 11 causes of rectal bleeding, along with additional symptoms of each and when to see a doctor.

Many health conditions and factors may cause or add to rectal bleeding.

1. Hemorrhoids

Hemorrhoids are inflamed anal blood vessels. They may develop on the outside or inside of the anus, appearing as small bumps that could occasionally bleed during bowel movements or when wiping.

In the United States, hemorrhoids affect about 1 in 20 people and nearly 50% of people over the age of 50.

Hemorrhoids, sometimes referred to as piles, may impact anyone. But, some factors may put people at a higher risk of developing them, such as:

Treatment for hemorrhoids usually involves over-the-counter (OTC) creams and suppositories that contain hydrocortisone. Taking warm baths, eating a high-fiber diet, and using stool softeners may also help reduce the discomfort of hemorrhoids.

If initial treatments fail, a doctor may perform minor surgery to remove the hemorrhoids.

2. Fistulas

A fistula occurs when an abnormal opening or pocket develops between two neighboring organs. Fistulas that appear between the anus and rectum, or anus and skin, could cause a discharge of white fluid and blood.

Doctors sometimes treat fistulas with antibiotics, but they may require surgery if they progress.

3. Fissures

Anal fissures occur when tissues lining the anus, colon, or rectum tear, resulting in pain and rectal bleeding. In some cases, passing a hard stool may cause a tear.

When anal fissures occur, they may cause bright red blood when passing a bowel movement.

Warm baths, a high-fiber diet, and stool softeners may help reduce symptoms of fissures. In severe cases, fissures may require prescription creams or surgery.

4. Diverticular disease

Diverticulitis occurs when small pockets called diverticula develop on the walls of the colon around a weakness in the organ’s muscular layers.

These pockets are common and do not usually cause symptoms or require treatment unless they become infected.

Infected and inflamed diverticula may cause rectal bleeding, which can present itself in two ways:

  1. Diverticulitis with rectal bleeding: This may cause a moderate blood flow that lasts a few seconds and will usually stop on its own. It is also accompanied by other symptoms, such as abdominal pain, nausea, and fever.
  2. Diverticular bleeding: This is typically painless, with large volumes of blood coming from the rectum. It may result in a significant amount of blood loss.

Both presentations of diverticulitis warrant medical evaluation, especially diverticular bleeding. Doctors may treat diverticulitis with antibiotics and, in severe cases, surgery.

Between 3-5% of people with diverticulitis experience diverticular bleeding.

5. Proctitis or colitis

Proctitis occurs when the tissues of the rectum become inflamed, often resulting in pain and bleeding.

Colitis occurs when the tissues lining the colon become inflamed. A type of colitis, called ulcerative colitis, may also cause ulcers or open, progressive sores that often bleed.

Treatments for proctitis and colitis vary depending on the causes. They range from antibiotics to surgery.

Common causes of proctitis and colitis include:

6. Gastroenteritis

Bacterial infections could cause inflammation of the colon and stomach, causing diarrhea that may contain mucus and blood. Viral gastroenteritis does not typically cause bloody diarrhea.

Treatment for gastroenteritis usually involves fluids, rest, and antibiotics or antivirals, depending on the exact cause.

7. Sexually transmitted infections (STIs)

Unprotected sexual intercourse that involves the anal area may spread a wide range of viral and bacterial diseases. These may cause inflammation of the anus and rectum. Inflammation increases the likelihood of bleeding.

Treatment for STIs usually involves either an antibiotic, antiviral, or antifungal medication based on the type of infection.

8. Prolapse

Weakened rectal tissues may allow a portion of the rectum to push forward or bulge outside of the anus, usually resulting in pain and, almost always, bleeding.

Rectal prolapse may occur at any age. However, females over the age of 50 are 6 times more at risk of developing a prolapse compared with males.

Typical treatment involves surgical intervention.

9. Polyps

Polyps are noncancerous, abnormal growths. When polyps grow on the lining of the rectum or colon they may cause irritation, inflammation, and minor bleeding.

In many cases, a doctor will remove polyps during a routine colonoscopy screening.

10. Colon or rectal cancer

Cancer that impacts the colon or rectum can cause irritation, inflammation, and bleeding. Blood may appear bright red or could cause stool to have a darker color.

Colon cancer is a very common form of cancer and tends to progress slowly, so it is often treatable if caught early.

Rectal cancer, while far rarer than colon cancer, is also usually curable if detected and treated in time.

Some cases of colon and rectal cancer develop from initially benign polyps. All cases of gastrointestinal cancer require treatment, which varies based on the stage of the cancer.

Treatment may involve surgery or a combination of chemotherapy, radiation therapy, and surgery.

11. Internal bleeding

Major injury to any of the gastrointestinal organs may result in internal bleeding that passes through the rectum. Severe gastrointestinal disease may also lead to internal bleeding.

A person should see their doctor if they suspect internal rectal bleeding. The doctor will likely order a colonoscopy.

Occasional minor to mild rectal bleeding is common and may not require medical attention.

This may include streaks or drips of blood in the stool, the toilet bowl, or when wiping. Some people may also find blood in their underwear, or the toilet water may appear reddish-pink after they go to the bathroom.

However, severe, chronic, or painful rectal bleeding may be a sign of a more serious underlying condition that requires treatment.

Rectal bleeding may also cause bad-smelling, dark, tarry stools mixed with dark red to black blood. In some cases, it may also cause serious blood loss.

Reasons to see a doctor for rectal bleeding include:

Reasons to seek emergency care for rectal bleeding include:

If bleeding is associated with an already diagnosed medical condition, a doctor will discuss ways to manage, reduce, and track symptoms.

If the cause of rectal bleeding is unknown, a doctor will normally ask questions about symptoms and the person’s medical history.

Depending on the severity, frequency, and accompanying symptoms, the doctor will work out if further testing is required. A doctor may also make a referral to a gastrointestinal or colorectal specialist.

Common tests associated with rectal bleeding include:

Specialists may perform additional tests, such as:

Treatment for blood in the stool or when wiping depends on the exact cause of the bleeding.

For example, OTC and prescription creams may often treat hemorrhoids, while a diet rich in fiber or surgery may help with diverticulitis.

Common treatments include:

  • antibiotics
  • topical creams or ointments
  • eating more fiber
  • procedures such as a colonoscopy, or, in some cases, surgery to remove part of the colon

A person should talk with a doctor about what treatment options work best for them.

In some cases, there is no real way to prevent minor cases of rectal bleeding. However, some factors are known to cause, contribute to, or worsen anal bleeding.

Common prevention tips for rectal, colon, and anal bleeding may include:

  • eating a balanced diet that is high in fiber
  • staying hydrated
  • not straining when going to the washroom
  • wiping the anus gently
  • treating chronic or prolonged constipation with home or OTC remedies, such as stool softeners
  • treating chronic or prolonged diarrhea with home or OTC remedies, such as bismuth subsalicylate
  • trying not to lift heavy objects unless required
  • maintaining a healthy body weight
  • taking long, warm baths frequently if experiencing symptoms
  • following treatment plans set out by a doctor for related medical conditions
  • trying to avoid spicy, rich, fatty, heavily processed, and refined foods
  • seeing a doctor about abnormal growths in the area
  • avoiding overuse of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • wearing a condom during anal sex

It’s important to speak with a doctor about abnormal gastrointestinal symptoms, as these may be a sign of underlying conditions.

Blood that appears when wiping is typically caused by bleeding in the lower gastrointestinal (GI) tract. This includes the colon, rectum, and anus.

Bright red blood on paper is usually caused by hemorrhoids or anal fissures.

That said, a person may experience dark red or black blood in the stool, but not on the paper. This indicates the bleeding occurs further in the intestine.

If bleeding occurs, a person should consider seeing their doctor if it is severe, worsens, or continues for several days.

Why is there blood when I wipe?

Several underlying conditions may cause blood when a person wipes. The reasons can range from benign conditions, such as hemorrhoids or a minor injury, to much more severe conditions, like cancer.

Why is there a small amount of blood when wiping?

A small amount of blood may indicate the presence of hemorrhoids or another minor issue. A small amount of blood may not require any specialized care or attention. However, if it gets worse or does not go away within a few days, a person should talk with their doctor.

Many times, a small amount of blood in the stool or when wiping is not a reason for concern. However, in some cases, it could be something serious.

There are many causes of rectal symptoms. If a person finds blood when wiping or in the toilet after a bowel movement, it is a good idea to see a doctor to rule out any serious conditions.