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Monday 6 July 2026

Peer Reviewed

Gastroenterology clinic

Bright red blood on the toilet paper

Gregor Brown

Recent articles on:
Gastrointestinal bleeding

Faecal occult blood tests. How and when to use (or not)

Bloody diarrhoea

Rectal bleeding in pregnancy

An approach to the patient with bloody diarrhoea

Bright red blood on the toilet paper

Recent articles on:
Digestive diseases

Persistent and chronic hiccups – when trivial becomes a conundrum

Typical reflux disease: recognition and management of resistance to therapy

Dysphagia – an updated guide to investigation

Anal disorders – haemorrhoids, abscesses and fissures

Coeliac disease – optimising long-term management

Abstract

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.

Key Points

Remember

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.