Bloody stool is almost always treatable, and in most cases the cause is something minor like hemorrhoids or a small tear in the anal lining. The steps you take depend on what’s causing the bleeding, how much blood you’re seeing, and what color it is. Bright red blood on toilet paper usually points to an issue near the end of your digestive tract, while black, tarry stools suggest bleeding higher up, like in the stomach or small intestine, where digestive enzymes have time to break down the blood before it exits.
What the Color of Blood Tells You
Bright red blood, whether it’s on the toilet paper, streaked on the stool, or dripping into the bowl, typically comes from the lower part of the digestive tract: the rectum, anus, or lower colon. This is the most common type people notice, and it’s often caused by hemorrhoids, fissures, or minor irritation.
Black, tarry, sticky stools are a different situation. The dark color comes from blood that has traveled through your entire digestive system, getting broken down along the way. This usually signals a problem in the stomach or upper intestine, such as an ulcer, and warrants prompt medical attention even if you feel fine otherwise. Maroon-colored stool falls somewhere in between and can point to bleeding in the middle of the tract.
The Two Most Common Causes
Hemorrhoids and anal fissures account for the vast majority of bright red rectal bleeding, and telling them apart is fairly straightforward based on how they feel.
Hemorrhoids are swollen veins in the rectum or around the anus. Internal hemorrhoids are often painless but bleed during bowel movements. External ones are more likely to cause a dull ache, pressure, or itching that can linger throughout the day. A thrombosed hemorrhoid, where a blood clot forms inside the swollen vein, can cause sudden, severe pain.
Anal fissures are tiny tears in the lining of the anus. They produce a sharp, searing pain during a bowel movement, sometimes described as passing shards of glass, followed by a deep ache that can last minutes to hours afterward. You’ll typically see bright red blood on the toilet paper. Fissures are most often caused by passing hard, large stools or by chronic diarrhea.
Home Remedies That Help Minor Bleeding
If you’re dealing with hemorrhoid or fissure-related bleeding, several home measures can reduce symptoms and promote healing within days to a few weeks.
Sitz Baths
Sitting in a few inches of warm water relaxes the muscles around the anus, improves blood flow to the area, and eases pain. Aim for water around 104°F (40°C). Soak for 15 to 20 minutes, and repeat three to four times a day if the discomfort is significant. You can use a plastic basin that fits over your toilet seat or simply use the bathtub.
Increase Fiber Gradually
Hard stools are the single biggest aggravator of both hemorrhoids and fissures. The recommended daily fiber intake is about 14 grams per 1,000 calories you eat, which works out to roughly 28 grams on a standard 2,000-calorie diet. Most people fall well short of that. Adding fiber-rich foods like beans, lentils, oats, berries, and vegetables softens stool and reduces straining. If you use a fiber supplement, increase the amount slowly over a week or two to avoid bloating and gas, and drink plenty of water alongside it.
Stay Hydrated and Avoid Straining
Water works together with fiber to keep stools soft. When you feel the urge to go, don’t delay, and don’t sit on the toilet longer than necessary. Scrolling your phone for 15 minutes on the toilet puts sustained pressure on rectal veins. Get in, go, get out.
Over-the-Counter Relief
Witch hazel pads, hydrocortisone creams, and petroleum jelly can soothe external hemorrhoids and protect irritated skin. For fissures, keeping the area clean and moisturized helps prevent re-tearing. Stool softeners can also be useful in the short term while you’re building up dietary fiber.
Medical Treatments for Persistent Bleeding
When home care isn’t enough after a few weeks, prescription options can help. For anal fissures that won’t heal, a doctor may prescribe a topical ointment that relaxes the anal sphincter and restores blood flow to the tear, giving it a better chance to close. These ointments work by widening blood vessels in the area. One common side effect is headaches, which leads some people to switch to an alternative formulation. If topical treatment fails, a minor procedure to relax the sphincter muscle can resolve chronic fissures.
For hemorrhoids that keep bleeding, office-based procedures include rubber band ligation (a band is placed around the base of the hemorrhoid to cut off blood flow) and infrared coagulation. These are quick, usually done without general anesthesia, and have short recovery times. Surgical removal is reserved for large or severely symptomatic hemorrhoids.
Medications That Increase Bleeding Risk
If you’re taking anti-inflammatory painkillers like ibuprofen or naproxen regularly, they could be contributing to your bleeding. NSAIDs roughly double the risk of bleeding from the colon, particularly from small outpouchings in the intestinal wall called diverticula. The risk climbs even higher if you’re also on a blood thinner. People taking warfarin alongside NSAIDs have nearly triple the risk of gastrointestinal bleeding compared to those on warfarin alone. If you suspect a medication is involved, talk to your prescriber before stopping anything, but it’s worth bringing up.
When Bleeding Signals Something Deeper
Not all rectal bleeding comes from a surface-level problem. Inflammatory bowel disease, particularly ulcerative colitis, causes bleeding from inflammation in the colon lining. The hallmarks are bloody diarrhea (often with mucus), urgent and frequent trips to the bathroom, abdominal cramps, fatigue, and weight loss. Sometimes rectal bleeding or urgency is the only early sign. These symptoms tend to come in flares rather than being constant, and they don’t respond to the home remedies that work for hemorrhoids.
Colorectal polyps and colorectal cancer can also cause blood in the stool, sometimes visible and sometimes only detectable through lab testing. This is why routine screening is recommended for all adults starting at age 45, even without symptoms. The U.S. Preventive Services Task Force lowered the starting age from 50 to 45 based on rising rates of colorectal cancer in younger adults. Screening continues through age 75 for people at average risk.
Signs You Need Emergency Care
Most rectal bleeding is not an emergency, but certain combinations of symptoms are. Call 911 or get to an emergency room if you have rectal bleeding along with any of the following:
- Dizziness or lightheadedness when you stand up
- Rapid, shallow breathing
- Fainting or confusion
- Cold, clammy, or pale skin
- Blurred vision
- Nausea
- Very low urine output
These are signs of shock from significant blood loss. You should also go to the ER if the bleeding is continuous or heavy (soaking through pads or filling the toilet bowl), or if it’s paired with severe abdominal pain or cramping. Don’t drive yourself. Have someone take you, or call for help.
Getting a Diagnosis
If your bleeding doesn’t stop within a couple of weeks of home treatment, recurs frequently, or is accompanied by changes in bowel habits, weight loss, or abdominal pain, your doctor will likely recommend a closer look. A colonoscopy allows direct visualization of the entire colon and rectum and can identify hemorrhoids, fissures, polyps, signs of inflammatory bowel disease, or other sources of bleeding. For people under 45 with new rectal bleeding, doctors use clinical judgment to decide whether a colonoscopy is needed or whether a more targeted exam of just the lower rectum is sufficient.
Stool-based screening tests that detect hidden blood are useful for routine cancer screening in people without symptoms, but they’re not a substitute for a colonoscopy when you’re actively seeing blood. If you can see the blood, the question isn’t whether it’s there. It’s where it’s coming from.