Patient information · Gastroenterology
Blood in your stool
never assume it is piles, even if you have them
Rectal bleeding is common and most often caused by haemorrhoids or a small tear. But bowel cancer is highly treatable when found early and frequently causes exactly the same bleeding — and having piles does not protect you from having something else as well. Blood should always be explained rather than assumed.
Call 999 or go to an emergency department if you have
- heavy bleeding that does not stop, or large clots
- black, tarry, foul-smelling stools
- dizziness, faintness or a racing heart with bleeding
- bleeding with severe abdominal pain and a tender abdomen
- bleeding with vomiting blood
- bleeding while taking anticoagulants, if heavy or persistent
Black tarry stools indicate digested blood from the stomach or upper gut and always need same-day assessment. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What the appearance suggests
- Bright red on the paper or dripping into the pan, not mixed with the stool — usually haemorrhoids or an anal fissure.
- Bright red mixed through the stool — from higher in the large bowel; needs investigating.
- Dark red or maroon, mixed in — from further up the bowel.
- Black and tarry (melaena), with a distinctive smell — from the stomach or small bowel. An emergency.
- Mucus with blood — suggests inflammation, polyps or infection.
- Pain on passing stool with bright blood — typically a fissure, which is intensely painful and benign.
Iron tablets and beetroot
Iron tablets turn stools black — but a smooth, non-sticky black without the characteristic tarry consistency or smell. Bismuth-containing indigestion remedies do the same. Beetroot, red food colouring and large amounts of tomato can look like blood. If in doubt, it is tested rather than guessed — and stopping the tablet for a few days settles it.
Features that need urgent investigation
- bleeding with a persistent change in bowel habit lasting three weeks or more
- unexplained weight loss, or a lump in the abdomen
- iron deficiency anaemia
- bleeding over the age of 50, particularly if new
- a family history of bowel cancer, especially under 50
- bleeding that persists despite treatment for piles or a fissure
Having piles does not exclude anything else
Haemorrhoids are extremely common — so common that plenty of people with bowel cancer also have them, and the bleeding gets attributed to the wrong thing. A diagnosis of piles should follow an examination, not precede one, and bleeding that continues after treating them needs looking into. This is the single commonest reason bowel cancer is diagnosed late in people under 50, in whom incidence has been rising.
The FIT test
The faecal immunochemical test detects tiny amounts of blood invisible to the eye. It is used both in national bowel screening and, increasingly, to assess symptoms — a negative FIT substantially reduces the likelihood of significant bowel disease and can avoid an unnecessary colonoscopy, while a positive result prompts one. It is a single small sample done at home.
What investigation involves
- Examination, including a rectal examination and often proctoscopy — brief, undignified, and it finds most causes
- Blood tests — full blood count and ferritin, to detect anaemia and iron loss
- FIT test
- Stool tests for infection and calprotectin where inflammation is suspected
- Colonoscopy — the definitive test, allowing polyps to be removed at the same time
- CT colonography as an alternative where colonoscopy is unsuitable
Treating the common causes
- Haemorrhoids — increase fibre and fluid, avoid straining and prolonged sitting on the toilet, topical treatment for symptoms, and banding or surgery if persistent.
- Anal fissure — the pain causes spasm which prevents healing, so treatment aims to relax the muscle: stool softeners, and a prescribed ointment such as GTN or diltiazem for six to eight weeks.
- Treat constipation properly in both, because straining is what caused and sustains them.
Why come to us. Most people put this off for months out of embarrassment, and that delay is the whole problem. We offer discreet, unhurried appointments seven days a week, with examination and proctoscopy in clinic, full blood count, ferritin and FIT testing in-house, and results explained in the same visit. Colonoscopy and CT colonography are arranged rapidly through our CQC-registered partners. Nobody will assume it is piles without looking.
Examined and tested discreetly, the same week
FIT and bloods in-house, colonoscopy arranged fast.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.