If you’re constipated, you’re probably already in enough anguish. Seeing streaks of blood on the toilet paper definitely doesn’t help. Your imagination might go to the worst scenarios: Could it be internal bleeding? An ulcer? Cancer?
The Most Likely Answer: You Strained Too Hard
Most of the time, rectal bleeding is not quite so sinister. “If you see blood after a bowel movement, this could be simply from a hard stool,” says Anthony Starpoli, MD, gastroenterologist in New York City.
When you’re constipated, your BMs are typically harder and thus more difficult to pass, so you strain and push and bear down. “There are very strong muscles at the anal sphincter, and when you pass a hard stool, you may tear the tissues there,” says Dr. Starpoli. This is called an anal fissure, or a tiny rip in the lining of your anal canal, according to the American Society of Colon and Rectal Surgeons. If you have an anal fissure, blood will appear bright red on your toilet paper since the blood is fresh and coming right from the rectum. You may also feel sharp pain during the bowel movement, and you might feel a lump or skin tag near the fissure.
Another result of straining is a hemorrhoid. Similar to anal fissures, these can create bright red blood on your toilet paper and cause pain when you push a BM. The difference is that hemorrhoids are caused by swollen or inflamed blood vessels around the anus and lower rectum.
“Everyone has hemorrhoids,” says Dr. Starpoli. “People think only some people have hemorrhoids; they don’t. Everyone is born with hemorrhoidal tissue… With a hard movement, you can scrape that tissue and get some bleeding.”
Other Reasons for Blood During a Bowel Movement
Anal fissures and hemorrhoids can go away on their own within a couple days, and you can prevent them by following lifestyle changes to prevent constipation.
However, if you’re seeing blood in your stool regularly, that’s cause for concern. “It is not normal to have rectal bleeding,” says Dr. Starpoli. “Rectal bleeding is really an alarm system that warrants some degree of investigation.”
Rectal bleeding can be caused by a number of issues in the esophagus, stomach, intestines, colon, rectum, or anus, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Here are some possible causes of rectal bleeding:
Inflammation of the esophagus
Diverticulosis and diverticulitis
If you’re experiencing bleeding without constipation (or you’ve changed your lifestyle to avoid constipation but are still seeing blood), talk to your doctor. You may be able to catch a serious condition and, if necessary, begin crucial treatment.