Symptoms · Back passage
Bleeding from the back passage without pain
The short answer
Bright red blood on the toilet paper or in the bowl, without much pain, is most often from piles (haemorrhoids). But bleeding can have other causes, including polyps, bowel inflammation and, less often, bowel cancer. Any bleeding from the back passage should be checked by a doctor, especially if you are over 40, if it lasts more than a couple of weeks, or if your bowel habit has changed. Go to the emergency room for heavy bleeding or dizziness.
How patients describe it
- Blood on the paper when I wipe
- Blood in the toilet bowl
- Blood mixed with my stool
- A lump that comes out when I pass stool
- Piles that bleed
Go to the emergency room now if you have
- Heavy bleeding, or passing clots
- Dizziness, fainting, a racing heart, or pale skin
- Black, tarry, sticky stool
- Blood with severe belly pain or fever
- Vomiting blood
What can cause it
Piles (haemorrhoids)
Painless bright red blood, sometimes with a soft lump that comes out when you pass stool.
Next step: Examination; most settle with simple measures.
Anal fissure
A streak of blood with sharp pain during and after passing stool.
Next step: Softer stools and warm baths; see a doctor if it continues.
Polyps or bowel inflammation (colitis)
Blood mixed with stool or mucus, sometimes with diarrhoea.
Next step: Colonoscopy (a camera test of the bowel).
Bowel cancer (less common)
Blood with a change in bowel habit, weight loss, tiredness, or anaemia.
Next step: See a doctor soon; a colonoscopy is needed.
Bleeding from bowel pockets (diverticular disease)
Sudden, painless, larger amounts of dark red blood, usually in older adults.
Next step: Go to the emergency room if heavy.
What you can do now
- Do not assume it is piles: have the bleeding checked by a doctor
- Keep stools soft with fibre and plenty of fluids, and do not strain
- Sit in a warm bath 2–3 times a day
- Tell the doctor about blood thinners, weight loss, tiredness, a change in bowel habit, or bowel cancer in your family
Tests your doctor may order
- Examination of the back passage
- A short camera test (proctoscopy)
- A blood count to check for anaemia, and a colonoscopy when needed
When is surgery needed?
- Piles that keep bleeding or are large can be treated with clinic procedures, such as banding, or by surgery.
- Bleeding from polyps or cancer is treated according to the colonoscopy findings, and your surgeon will explain the options.
Related operation guides
Questions people ask
Is bleeding when I pass stool always piles?
No. Piles are the most common cause, but bleeding can have other causes, so it should always be checked.
Do I need a colonoscopy?
Often, yes. The doctor decides after asking about your age, your symptoms and your family history.
Can piles be treated without surgery?
Yes. Fibre, fluids, warm baths and creams help many people, and clinic procedures can treat some. Surgery is for piles that are large or keep bleeding.
This page gives general information and does not replace the advice of your treating team. In an emergency, go to the nearest emergency room.