Blood on Toilet Paper: Is It Hemorrhoids or Anal Fissure?

Blood in the stool?

Hello, about a year ago in October, I had a bowel movement that was somewhat hard, and there was blood on the toilet paper afterward.
Since then, when I have a bowel movement, it tends to be urgent, but not always very hard (the stool comes out quickly), and there is red blood on the surface of the stool or on the toilet bowl.
The amount is not much, but it is noticeable.
Could this be due to hemorrhoids or an anal fissure? Do I need to undergo a colonoscopy? After using the restroom, I feel a bit uncomfortable in the anal area, but it is not very painful.
Thank you for your help.

yu, 20~29 year old female. Ask Date: 2021/04/14

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
The causes are often related to constipation or diarrhea, and mild hemorrhoidal bleeding can also present similarly.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
Warm sitz baths can help relieve pain, maintain cleanliness, and promote blood circulation.
Over-the-counter hemorrhoid suppositories can also be used.
If symptoms persist without improvement, it is advisable to consult a physician.
At this age, a colonoscopy is generally not recommended unless the bleeding does not improve.

Reply Date: 2021/04/14

More Info

When you notice blood on toilet paper after a bowel movement, it can understandably cause concern. Based on your description, it is likely that the blood is due to either hemorrhoids or an anal fissure. Both conditions are relatively common and can occur for various reasons, including straining during bowel movements, passing hard stools, or even sitting for prolonged periods on the toilet.

Hemorrhoids are swollen veins in the lower rectum or anus, similar to varicose veins. They can be internal (inside the rectum) or external (under the skin around the anus). Symptoms of hemorrhoids include bright red blood on the toilet paper, pain or discomfort during bowel movements, and sometimes a lump near the anus. The blood is usually bright red, indicating that it is fresh and comes from the lower part of the gastrointestinal tract.

Anal fissures, on the other hand, are small tears in the lining of the anus. They can occur due to passing hard stools or straining during bowel movements. Symptoms of an anal fissure include sharp pain during and after bowel movements, a visible tear, and blood on the toilet paper or in the stool. The pain associated with fissures can be quite intense, often described as a "burning" sensation.

Given that you mentioned the blood is not excessive and is typically found on the stool or toilet paper, it leans more towards hemorrhoids, especially if you have experienced any straining or hard stools. However, the presence of blood, regardless of the amount, should not be ignored, as it can also indicate other gastrointestinal issues.

Regarding your question about whether you need a colonoscopy, it is generally recommended to consult a healthcare professional if you experience rectal bleeding, especially if it persists or is accompanied by other symptoms such as significant pain, changes in bowel habits, or weight loss. A colonoscopy can help rule out more serious conditions, including colorectal cancer, especially if you are over the age of 50 or have a family history of colorectal issues.

In the meantime, here are some recommendations to manage your symptoms:
1. Dietary Changes: Increase your fiber intake by consuming more fruits, vegetables, whole grains, and legumes. This can help soften your stool and reduce straining during bowel movements.

2. Hydration: Drink plenty of water throughout the day to help keep your stools soft.

3. Over-the-Counter Treatments: Consider using topical treatments such as hydrocortisone creams or witch hazel pads for hemorrhoids, or sitz baths to soothe the area.

4. Avoid Straining: When using the bathroom, try to relax and avoid straining. If you feel the urge to go, don’t delay.

5. Regular Exercise: Engaging in regular physical activity can help promote healthy bowel function.

If your symptoms persist or worsen, or if you notice any new symptoms, it is crucial to seek medical attention. A healthcare provider can perform a thorough examination and may recommend further diagnostic tests to determine the cause of your symptoms. Remember, while hemorrhoids and anal fissures are common and often manageable, it is always best to err on the side of caution when it comes to your health.

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