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Bleeding In The Loo
Bleeding In The Loo
Bleeding In The Loo

Several conditions can cause this distressing situation. Here’s a brief guide to understanding them.

Blood in the stools can come from the anus or from higher up in the colon and rectum. Typically, bleeding from the anus occurs during bowel movement and the blood looks fresh.

Spotting blood on the toilet paper or in your stools can throw you into a state of panic, but it’s not always cause for worry, and it’s not uncommon.

There are a few possible reasons for rectal bleeding, some which are considered more serious than others. See your doctor immediately if you think you might be suffering from the following:

Colorectal Cancer

Symptoms include changes in bowel habits, passing out blood and/or mucus, feeling that the act of passing motion is not complete after going, vague abdominal pain or bloating, lethargy, giddiness and breathlessness from anaemia.

Blood in the stools may be a symptom of colorectal cancer, which is cancer of the colon and the rectum. The blood can come from the anus or from higher up in the colon and rectum. Typically, bleeding from the anus occurs during a bowel movement and the blood looks fresh, and may or may not be accompanied by pain and discomfort. You should be concerned if the blood is dark in colour, stale or clotted.


Polyps are abnormal growths in the internal lining of the large intestine (colon and rectum). They are one of the most common conditions affecting the colon and rectum, occurring in 15–20% of the adult population. Although most polyps are benign, certain polyps can eventually turn cancerous.

Typically, polyps cause no symptoms and are discovered incidentally during an examination of the colon or rectum. Some polyps can cause bleeding, mucous discharge, and changes in bowel habits, but rarely do they cause abdominal pain.

Diverticular Disease

Diverticular disease is also known as diverticulosis. This is a condition of the gastrointestinal tract in which a small part of the stomach or intestine wall bulges out and forms a pocket known as a diverticulum. It is quite common among people aged 40 and above, but most do not experience symptoms, and even fewer require surgery to treat it.

What happens most of the time is inflammation or infection at the site of the diverticuli. This causes fever and pain, and loose stools and diarrhoea. In severe cases, perforation and abcesses may form, requiring hospitalisation and even surgery.

Internal bleeding of the colon is another possible complication. This is more prevalent among Asians, and happens when blood vessels at the edge of the diverticuli break and bleed, causing either dark red blood or blood clots to be passed out with the stools.

The following conditions usually do not lead to serious complications, but it is wise to monitor them closely:


Constipation occurs when a person has difficulty passing motion, and is usually associated with hard stools. There are several possible reasons why one may experience constipation, such as inadequate water and fibre, a sedentary lifestyle, sudden changes in one’s environment or diet, travel, and pregnancy.

Repeated suppression of the urge to pass motion may also result in constipation. By delaying the process, the stools are jammed in the rectum and overstretch it. And since the colon tends to absorb moisture from the stools, the initial piece is large and hard when one eventually goes.

Constipation does not in itself cause bleeding, but the hardened stools may cause piles, anal fissures or tears in the lining of the anus, all of which can result in fresh bleeding.

Haemorrhoids (Piles)

This is a condition where blood vessels in the anal canal become abnormally swollen and enlarged.

Among the possible causes of haemorrhoids are prolonged upright posture, which raises pressure in the veins, chronic constipation, ageing, pregnancy as well as childbirth.

There are two types of piles: external and internal. External ones develop on the outer part of the anus, while internal ones start from the upper part of the anal canal. With internal ones, the wall of the swollen blood vessel gets stretched and thinned out so that it breaks easily. Once this happens, there is bleeding. The fresh blood passes out with the stools.

Piles varies in severity and may not always show visible symptoms. In the case of first- and second-degree piles, the lumps are found inside the anal passage and can be managed by drinking more fluids, eating high-fibre foods, and straining less in the toilet.

For severe piles, persistent lumps may lie outside the anus, causing itching, bleeding and pain in the anal area.

Anal Fissure

This is a tear in the lining of the anus. It is usually caused by a hard and dry bowel movement — which tears the anal lining — diarrhoea, and inflammation of the anorectal area. Anal fissures can cause pain, bleeding and/or itching.

What To Do

If you notice blood in your stools, observe the pattern of bleeding and the extent of pain, which can give you a good idea of its cause.

If the blood found is bright red, fresh and covers the surface of the stool, it is likely due to a superficial wound near the anus, especially if the stool is hard and painful to pass. This symptom is typically not linked to cancer and should not be cause for panic.

When the blood is stale or dark-coloured, it means the bleeding has occurred higher in the digestive tract (in the colon or rectum). This indicates a high possibility of more serious problems such as cancer.

If the bleeding occurs frequently and lasts more than a few days, seek help from a medical specialist.

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Ho Kok Sun Colorectal

Colorectal Surgeon

3 Mount Elizabeth,
Mount Elizabeth Medical Centre
#04-08, Singapore 228510

Tel (+65) 6737 2778
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