Gastroenterology clinic

Bright red blood on the toilet paper

Gregor Brown



Occasional bright red rectal bleeding is common and may not require any therapy once a sinister cause has been excluded. Here, Dr Brown outlines his approach to per rectal bleeding.

Article Extract

  • It is useful to distinguish outlet bleeding (bright red rectal bleeding seen on the toilet paper or in the bowl) from altered bleeding (dark blood, and/or mixed in with stool), as the latter suggests a non-anal and probably more serious cause.
  • Intermittent minor bright rectal bleeding is common, and usually due to benign anal pathology such as haemorrhoids or anal fissure (Figure 1).
  • Important but less common causes include cancer, large polyps, inflammatory bowel disease and radiation proctitis.