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Bright red blood on the toilet paper

Gregor Brown MB BS, FRACS

Occasional bright red rectal bleeding is common and may not require any therapy once sinister cause has been excluded. Here, Dr Brown outlines his approach to rectal bleeding

• It is useful to distinguish outlet bleeding (bright red rectal bleeding seen on the toilet paper or in the bowl) from altered bleeding (dark blood, and/or mixed in with stool), as the latter suggests a non-anal and probably more serious cause.
• Intermittent minor bright rectal bleeding is common, and usually due to benign anal pathology such as haemorrhoids or anal fissure.
• Important but less common causes of rectal bleeding include age above 40 years, dark or heavy bleeding, change in bowel habit, abdominal pain, anaemia and a family history of bowel cancer.

Persistent bleeding

Needs investigation even in young patients. Simple anal conditions can be treated with confidence if a more proximal lesion has been excluded.