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In general, bright-red blood means the bleeding has come from somewhere near your anus and is a typical sign of piles (haemorrhoids) or a small tear (anal fissure) in the skin of your anus.

Although these are common problems, don’t let embarrassment stop you seeing your doctor . You should always get rectal bleeding checked to rule out more serious causes. Around 10% of adults experience rectal bleeding in most places. If the blood is darker in colour and sticky, the bleeding may have occurred higher up your digestive system. This type of bleeding can turn your faeces black or plum-coloured (known as melaena). Having plum-coloured, dark and sticky faeces may be a medical emergency – you should see your doctor immediately

Causes of Blood in Stool
Blood in the stool means there is bleeding somewhere in your digestive tract. Sometimes the amount of blood is so small that it can only be detected by a fecal occult test (which checks for hidden blood in the stool). At other times it maybe visible on toilet tissue or in the toilet after a bowel movement as bright red blood. Bleeding that happens higher up in the digestive tract may make stool appear black and tarry.

Some of the more unusual causes of rectal bleeding include
• anticoagulant drugs – such as warfarin or aspirin, which are taken to reduce your chance of a blood clot but can sometimes cause internal bleeding.
• inflammatory bowel disease – such as Crohn’s disease or ulcerative colitis. These long-term conditions cause the lining of the bowel to become inflamed. Crohn’s disease affects the gut higher up, whereas ulcerative colitis affects the large bowel and rectum further down. Both tend to cause bloody diarrhoea.
• bowel polyps – small growths on the inner lining of the colon or rectum. These are common and often don’t cause symptoms, but may lead to a small amount of blood in your stool. Although usually harmless, colon polyps can grow, bleed and become cancerous.

Colon polyps are growths in the inner lining, or mucosa, of the colon, or large intestine. It has been well established that colon cancers develop from colon polyps. The three primary types of colon polyps are hyperplastic, inflammatory, and adenomatous. The vast majority of colon polyps are benign (not cancerous), but adenomatous colon polyps have the greatest potential to turn into colon cancer.

Signs and symptoms of colon polyps may include blood in the stool, constipation, and diarrhea. Most colon polyps do not produce any signs or symptoms, which makes colon cancer screening with colonoscopy at age 50 very important. Colonoscopy allows for removal of colon polyps for microscopic analysis. In some instances, removal of the colon polyp is therapeutic and prevents the development of colon cancer in the future. Colon polyps rarely recur once completely removed.
• sexually transmitted infections (STIs) – any sexual activity involving the anal area can spread STIs, which may sometimes lead to rectal bleeding. Read more about the risks of anal sex.
The first question would be ,

Is it bowel cancer?
Many people with rectal bleeding worry they may have bowel cancer. While rectal bleeding can be a sign of early-stage bowel cancer, other factors may also be present for your doctor to think you’re at risk. You should be urgently referred to a specialist with suspected bowel cancer if you have rectal bleeding and:
• you’re aged 40 or older and have passed looser or more frequent stools for the last six weeks
• you’re aged 60 or older and the bleeding has lasted for six weeks or more
• your doctor has found an abnormality (such as a lump) after examining you
• you also have anaemia (a reduced number of red blood cells)
• you have a family history of bowel cancer
• you have ulcerative colitis
Bowel cancer is sometimes called colon or rectal cancer, depending on where the cancer starts.
Cancer – Blood in stool can be a symptom of cancer along the digestive tract. Colon cancer and anal cancer are two types that can cause bleeding; sometimes not noticeable to the naked eye to more severe bleeding.

Common causes of rectal bleeding
Some of the most common causes of visible rectal bleeding in adults are outlined below. However, don’t try to diagnose yourself, and always see your doctor for a proper diagnosis.
• piles (haemorrhoids) – swollen blood vessels in and around the rectum. They can bleed when you have a bowel movement, which can leave streaks of bright-red blood in your stools and on the toilet paper. Piles may also cause itchiness around your anus. They often heal on their own.

Hemorrhoids represent swollen and inflamed veins in the anus and lower rectum. They can be caused by a variety of factors including straining during bowel movements, obesity, pregnancy, prolonged sitting, chronic constipation, and a low-fiber diet. Hemorrhoids can be internal or external. Internal hemorrhoids are located above the rectum and are typically painless. External hemorrhoids occur under the skin around the anus and can be exquisitely painful. Damage to the delicate surface of a hemorrhoid may cause it to bleed.

Signs and symptoms of hemorrhoids may include blood in the stool, itching or irritation in the anal region, and a painful swelling or lump around the anus. It is estimated that just about 50-percent of adults have experienced hemorrhoid symptoms by the age of 50. Mild hemorrhoid symptoms are typically treated with over-the-counter agents. Severe hemorrhoid symptoms may require medical procedures such as removal of the hemorrhoid, rubber band ligation, sclerotherapy, laser therapy, or stapling.

• anal fissure – a small tear in the skin of the anus, which can be painful as the skin is very sensitive. The blood is usually bright red and the bleeding soon stops. You may feel like you need to keep passing stools, even when your bowel is empty. It often heals on its own within a few weeks. Signs and symptoms of anal fissures may include itching, pain with bowel movements, and blood in the stool. Some individuals suffer from pain secondary to spasm of the anal sphincter, or ring of muscle at the end of the anus. Diagnosis of anal fissures is made by visual inspection of the anus and canal. Most cases of anal fissures resolve with conservative over-the-counter treatments. Chronic anal fissures may need prescription medication and/or surgery (lateral sphincterotomy) to achieve healing.

• Crohn’s Disease
Crohn’s disease is one of two recognized forms of inflammatory bowel disease (IBD). Its course is chronic, or long lasting. The disease can affect any part of the gastrointestinal (GI) tract from the mouth to the anus, although it most commonly affects the small intestine and the beginning of the large intestine, or colon. The exact cause of Crohn’s disease is unknown, but most scientists agree it is an autoimmune disease (immune system cells mistakenly attack healthy body cells).
Signs and symptoms of Crohn’s disease may include diarrhea, abdominal pain and cramping, blood in the stool, fatigue, anemia, nausea, and weight loss. Diagnosis of the disease is most commonly sought with visual examination of the colon, or colonoscopy. There is no cure for Crohn’s disease, but medication can be prescribed to reduce symptoms and improve an individual’s
quality of life. Unfortunately, the disease can sometimes progress to where surgery is needed for treatment.
• anal fistula – a small channel that develops between the end of the bowel, known as the anal canal or back passage, and the skin near the anus (the opening where waste leaves the body). They’re usually painful and can cause bleeding when you go to the toilet.
• angiodysplasia – abnormal blood vessels in the gastrointestinal tract, which can cause bleeding. It’s more common in older people and can cause painless rectal bleeding.
• gastroenteritis – a viral or bacterial infection of the stomach and bowel, which your immune system usually fights off after a few days. It can cause diarrhoea containing traces of blood and mucus, as well as vomiting and stomach cramps.

• Peptic Ulcers
Peptic ulcers refer to open sores caused by exposure to stomach acids. The most common types of peptic ulcers occur in the stomach (gastric ulcer) and duodenum (duodenal ulcer). The duodenum is the first portion of the small intestine. Individuals may have both types of peptic ulcers at the same time. Peptic ulcers are caused by infections with the bacteria Helicobacter pylori or the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen.
Signs and symptoms of peptic ulcers may include boring-type upper abdominal pain, nausea, vomiting, blood in the stool, bloating, fatigue, shortness of breath, and lightheadedness. Diagnosis of peptic ulcers is readily made by visualization on upper endoscopy (a scope to view the esophagus, stomach, and duodenum) or upper GI series (X-rays of these areas with contrast). Peptic ulcers associated with H. pylori are typically treated with acid suppression therapy and triple antibiotics.

• diverticula – small bulges in the lining of your lower bowel. These contain weakened blood vessels that can burst and cause sudden, painless bleeding (you may pass quite a lot of blood in your stools).
• bowel cancer (colon or rectal cancer) – you should always get checked by your doctor if you have rectal bleeding. The only symptom of bowel cancer may be rectal bleeding in the early stages, so don’t ignore it. Bowel cancer can be treated more easily if it’s diagnosed at an early stage. Colon cancer is a malignant tumor arising from the mucosa, or inner lining, of the colon. It is the third most common cancer diagnosed in the United States. Risk factors for colon cancer include a family history of colon cancer, colon polyps (specifically adenomatous colon polyps), and ulcerative colitis. Most colon cancers develop from colon polyps, which makes colon cancer screening paramount at age 50. The removal of colon polyps can prevent colon cancer.

Signs and symptoms of colon cancer may include diarrhea, constipation, narrowing of the stool, blood in the stool, abdominal pain, weakness, and weight loss. Screening for colon cancer may be accomplished with a fecal occult blood test, sigmoidoscopy, barium enema, or colonoscopy. Colonoscopy is ideal because abnormal lesions can be biopsied and categorized as precancerous, malignant (cancerous), or benign (noncancerous). Surgery is the most common treatment for colon cancer.

• Ulcerative Colitis

Ulcerative colitis is one of two recognized forms of inflammatory bowel disease (IBD). It is a chronic (long lasting) disease of the colon, or large intestine, characterized by inflammation and tiny ulcers (open sores). Ulcerative colitis only affects the mucosa, or lining, of the colon. Most scientists agree the disease is the result of an abnormal response by an individual’s immune system, or autoimmunity.

Signs and symptoms of ulcerative colitis may include persistent diarrhea, abdominal pain, blood in the stool, fatigue, loss of appetite, and weight loss. Ulcerative colitis can easily be diagnosed via colonoscopy, or visual examination of the colon. There is no known cure for ulcerative colitis. Therapy is geared toward prescription medication that suppresses inflammation and allows healing of the colon. Medical therapy is not successful in up to 25-percent of individuals with ulcerative colitis. At that point, surgical intervention may be needed to remove parts of the colon (colectomy).

Investigations that can be carried out?
If your doctor needs to examine you to find out what’s causing your rectal bleeding, they may carry out a rectal examination. This involves putting a gloved finger inside your bottom (rectum).
There’s no need to feel embarrassed or nervous: it’s a quick and painless procedure that doctors are used to doing. The examination usually takes one to five minutes, depending on whether your doctor finds anything unusual. You may be referred to a hospital or specialist clinic if further examinations and tests are needed.
Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum — though not all cancers or polyps bleed. … If blood is detected through a fecal occult blood test, additional tests may be needed to determine the source of the bleeding.

Bright red blood covering the surface of the stool means the bleeding is at or just above the anus. It is a common symptom and usually turns out to be a tear of the anus itself (anal fissure), especially if the stools are very hard and painful to pass. Less commonly such bleeding can be due to a proctitis (inflammation of the lower rectum usually due to IBD) or a rectal tumor. Inspection of the anus and sigmoidoscopy can identify these.
In those who have a family history of colon cancer, or who are older than 50 years of age, the doctor may order a colon examination to exclude it – usually a colonoscopy.

Bright red blood mixed with the stools indicates the bleeding is acute and likely in the colon. Causes include infections, IBD, diverticula, or tumor. If a great deal of blood is lost, an emergency colonoscopy will be necessary. Sometimes bleeding from the stomach can be so perfuse that it appears as bright red blood from the rectum. In this case, the individual may be faint and show signs of blood-loss shock – an emergency situation.

Perculiar circumstances
A sudden change in bowel habit or other gut symptom in someone over 50 years of age should attract diagnostic attention. Sometimes that means a cancer in the colon, esophagus, or stomach, requiring endoscopy to exclude it.
The gut goes to sleep when we do, and is normally undisturbed by functional gut symptoms, although there are exceptions. Therefore, night-time pain, when it occurs, may be a symptom of structural disease and requires further examination.

Many structural gut diseases run in families, so it is important to know and report family health history. Colon cancer, IBD, and celiac disease are more common in the first-degree relatives of affected persons. A family history of colon cancer should prompt a colonoscopy to screen for precancerous polyps whose removal can prevent cancer.