Rectal bleeding and piles
Most rectal bleeding is piles. The danger is assuming every bleed is piles, because the exceptions are exactly the cases where waiting costs the most.
Also known as: Blood in stool · Haemorrhoids · Piles · Bleeding from the back passage
Understanding rectal bleeding and piles
What the colour tells us
Where the blood comes from changes how it looks by the time you see it, which is why we always ask.
Bright red blood on the tissue or on the surface of the stool has travelled only a short distance, so it comes from low down near the back passage. That is the pattern haemorrhoids and anal fissures most often make.
Dark red blood mixed evenly through the stool suggests a source higher in the colon. A black, tarry, strong-smelling stool, called melaena, means blood has been partly digested on its way down, pointing to the stomach or upper gut, and that needs seeing the same day.
Understanding rectal bleeding and piles
Why piles are usually the answer
Haemorrhoids are swollen blood vessels in the anal canal. They are extremely common, and in Lagos the usual contributors are all present: low-fibre diets, insufficient water, long hours sitting, and straining from constipation. Pregnancy is another frequent cause.
They typically bleed bright red, often dripping into the bowl or seen on the paper, with the blood separate from the stool rather than mixed in. Itching, aching, a feeling of incomplete emptying, or a lump that appears on straining are all common.
Anal fissures, small tears in the lining, are the other frequent cause and are distinguished by sharp pain during and after passing stool.
Understanding rectal bleeding and piles
When it is not just piles
The clinical problem is that early bowel cancer and polyps can bleed in a way that mimics haemorrhoids almost perfectly. You cannot tell them apart by the bleeding alone, and neither can we without looking.
That is why the presence of any additional feature changes the advice entirely, and why age matters so much.
- Blood mixed through the stool rather than on its surface
- A persistent change in how often or how you go
- Unintended weight loss
- Iron-deficiency anaemia
- New bleeding after the age of 45
- A first-degree relative who has had bowel cancer
Understanding rectal bleeding and piles
The age that changes the advice
From around 45, new rectal bleeding warrants a colonoscopy even when it looks exactly like piles, and even when piles are visibly present. Having haemorrhoids does not protect you from also having a polyp.
This is not expecting the worst. A colonoscopy either rules out anything sinister, which is the usual outcome and a genuine relief, or finds a polyp while it is still nothing and removes it. Both are good mornings.
Understanding rectal bleeding and piles
How we investigate it
Assessment starts with an examination of the back passage, which often identifies piles or a fissure directly.
A colonoscopy examines the entire large bowel and settles the question of where the blood is coming from. If piles are the cause, they can often be treated in the same sitting by banding. If a polyp is found, it is removed. If anything needs a closer answer, we biopsy it and move quickly.
Understanding rectal bleeding and piles
Treating piles
Most haemorrhoids improve substantially with simple measures, and these are worth doing properly before anything else:
- Increase dietary fibre and drink considerably more water
- Do not strain, and do not sit on the toilet for long periods
- Treat constipation actively rather than tolerating it
- Topical treatments for short-term symptom relief
- Rubber band ligation during colonoscopy for persistent internal piles
- Surgical treatment for large or prolapsing piles that do not respond
Common questions
Is blood in the stool always serious?
No. Most is caused by haemorrhoids or a small anal fissure. But dark blood, blood mixed through the stool, or any new bleeding after 45 should be properly investigated.
Can I have piles and something else at the same time?
Yes, and this is the trap. Finding piles does not exclude a polyp or cancer higher up, which is why bleeding after 45 earns a full colonoscopy regardless.
Can piles be treated during a colonoscopy?
Often yes. Internal haemorrhoids can be banded during the same procedure while the rest of the bowel is also checked.
Bowel cancer
Colorectal cancer is rising in Nigeria and patients are presenting younger. It is also one of the most preventable cancers there is, provided you look before symptoms appear.
Bowel polyps
A polyp is a small growth on the bowel wall. Most are harmless, but some are the seed from which bowel cancer grows, which is why we remove them when we find them.
Irritable bowel syndrome
IBS is real, common and genuinely disruptive, but it does not damage the bowel and it does not lead to cancer. The diagnosis is made once the things that look like it are excluded.
Talk to the unit
This page is general information, not a diagnosis. If it describes you, a short consultation decides what, if anything, you need. Call +234 707 056 6272 or message +234 707 056 6272 on WhatsApp.