Bleeding from the bottom (rectal bleeding)

A small amount of one-off bleeding from the bottom is not usually a serious problem. But a GP can check.

Check if you're bleeding from the bottom

You might be bleeding from the bottom if you have:

• blood on your toilet paper
• red streaks on the outside of your poo
• pink water in the toilet bowl
• blood in your poo or bloody diarrhoea
• very dark poo (this can be blood mixed in poo)

A small amount of one-off bleeding can often go away on its own without needing treatment.

What happens at the GP appointment

If you have bleeding from your bottom, a GP will check what's causing it.

They might:

• check your bottom (rectum) with a gloved finger (rectal examination)
• ask for a sample of poo for testing
• refer you to a specialist for tests

Common causes of bleeding from the bottom

If you have other symptoms, this might give you an idea of the cause.

Do not self-diagnose. See a GP if you're worried.

Bright red blood on toilet paper, streaks on poo, pink toilet water

Possible causes of bright red rectal bleeding

Symptoms	Possible causes
Bright red blood and pain when pooing, itchy bottom, lumps	Piles (haemorrhoids)
Bright red blood and pain when pooing – often after constipation	A small tear in your anus (anal fissure)
Bleeding with or without lumps, itching or pain	Sexually transmitted infections (STIs) like genital warts, damage from anal sex
Bright red blood without pain	Side effect of medicine to help prevent blood clots like warfarin and apixaban (anticoagulants) or aspirin. Broken blood vessels in the gut (angiodysplasia)

Blood in poo or blood with slime

Poo can look like it's mixed with blood if you've eaten a lot of red or purple foods like tomatoes and beetroot.

But it's sometimes a sign of something else. A GP can check if you're worried.

Possible causes of slime or blood in your poo

Symptoms	Possible causes
Blood and yellow slime when pooing, irritated anus, non stop bottom pain	Anal fistula
Bloody diarrhoea with clear slime, feeling and being sick	Tummy bug (gastroenteritis)
Bloody diarrhoea, tummy cramps and pain, feeling bloated	An inflammatory bowel disease (IBD) like ulcerative colitis or Crohn's disease
Blood in poo	Bleeding in the anus, bowel or lower gut from injury or another problem
Blood in poo, change in pooing habits (like looser poo, diarrhoea or constipation), slime with poo	Bowel polyps, early signs of bowel cancer

Very dark or black blood or poo

Poo can look very dark or black if you:

• take iron tablets
• eat a lot of dark foods like liquorice and blueberries

But it's sometimes a sign of something else. A GP can do a test to check this if you're worried.

Possible causes of very dark or black blood coming from your bottom

Symptoms	Possible causes
Dark or black poo	Bleeding in the stomach or gut – can be from injury or a side effect of medicine to help prevent blood clots like warfarin and apixaban (anticoagulants) or aspirin
Dark blood or poo with tummy pain or cramps	Stomach ulcer
Dark blood without pain	Side effect of medicine to help prevent blood clots like warfarin and apixaban (anticoagulants) or aspirin