About Rectal Bleeding In IBS

RECTAL BLEEDING IN IBS can occur, so if you've experienced this, you'll find the help you need including the causes of blood in your stool, investigations and treatment options available to you.

Its important to realise at this point that serious causes such as BOWEL CANCER only account for about 1% of cases.

Bleeding on the tissue is usually traumatic or from problems around your anus, but If you've noticed blood  either in to the toilet pan or on wiping you should have this investigated.

Most people will notice bleeding at some point in their lives, so what causes this?

Select A Topic:

  • Anal Causes - learn about "piles" as a cause of your bleeding
  • Bowel Causes - find out bowel causes that could explain your symptoms

Rectal Bleeding In IBS Picture
The Key To IBS Freedom
The Key To IBS Freedom

Anal Causes

The most common cause of rectal bleeding in IBS is HAEMORRHOIDS (commonly called piles) and FISSURES (a crack occurs in the skin of your anus or "bum hole"). These conditions are totally benign, but can be very painful.

They are caused by excessive straining and constipation, so they are commonly seen in pregnancy. However, there are bowel conditions linked to straining and constipation so you should always have these investigated by your doctor.

One of these is Crohn's disease, an inflammatory condition of the bowel, but other conditions such as coeliac disease, diverticular disease and bowel cancer can be occasionally be linked.

Conditions that can affect the "anal skin" such as dermatitis (eczema), psoriasis, thrush (candida infection) and lichen sclerosis can cause this.

If you have an "ITCHY BOTTOM", it is usually due to worm infestation (threadworms) or haemorrhoids.

When you feel a lump it can rarely indicate anal cancer although more commonly it is due to either a thrombosed haemorrhoid, a benign pedunculated hyperplastic polyp  or anal skin tag.

Haemorrhoids PictureHaemorrhoids

Bowel Causes

There are BOWEL CAUSES of rectal bleeding in IBS, but these are not as common and are unrelated to the condition itself.

I've already mentioned Inflammatory conditions of the bowel such as inflammatory bowel disease or IBD (crohn's disease, ulcerative colitis) can occasionally underline your symptoms and I've occasionally seen people misdiagnosed with IBS when the actually had a low-grade form of IBD.

Other conditions of the bowel that can present with rectal bleeding include:

  • Polyps - adenomas, hyperplastic
  • Bleeding blood vessels (angiodysplasia)
  • Diverticular disease
  • Coeliac disease
  • Rarely cancer of the bowel.

These conditions can easily be mistaken by sufferers as haemorrhoids which is why you should always see your doctor before you make any self-diagnosis.

colon cancer PictureColon Cancer

Bowel Investigation

I've already mentioned that rectal bleeding in IBS should be INVESTIGATED.

When you go to your doctor they will be very understanding and aware of your anxiety and concerns about this.

You'll be asked questions about the bleeding including how long you have had it, whether it is fresh or old blood, whether you have an itchy bottom (doctors call this pruritis ani) which is often associated with piles or worm infestation, if there is any soreness or discharge, and if there is any family history of bowel diseases including cancer.

Colonoscopy PictureColonoscopy

They will examine the area and may perform a proctoscopy or rigid sigmoidoscopy (this is a rigid plastic or metal tube that is inserted through the anus and allows your doctor to look in the lowest part of your bowel known as the rectum).

If they haven't got this facility, they may refer you to a gastroenterologist or surgeon to investigate this further. 

Tests that are commonly performed include:

  • Flexible sigmoidoscopy - a flexible camera test requiring the insertion of a camera through your anus to look at the left side of your large bowel and rectum.
  • Colonoscopy - a  more extensive camera test to look at your entire colon. This usually requires sedation.
  • CT colonography - a special x-ray examination to visualize your large bowel. Has the advantage of seeing other abdominal organs too.
  • Barium enema - a less used investigation these days, but one that involves the insertion of barium dye in to the colon as an enema. Barium contrast is then visualized using x-rays.

Treatment of Rectal Bleeding In IBS

The type of treatment really DEPENDS ON THE CAUSE and this is best discussed with your doctor at the time of consultation.

Haemorrhoid treatment

If HAEMORRHOIDS are the cause, they can be treated with creams and suppositories or surgically managed by either banding or hemorrhoidectomy - a surgical procedure to remove your them.

Maintaining a diet of at least 5 fruit and vegetables a day will provide the essential fiber you need to help prevent straining, a common reason for piles.

If you are unsure what fruit and veg to have, I would recommend you look in the diet section and particularly the low FODMAP diet. This diet outlines fruit and vegetables that are good in IBS and one's which should be avoided.

You should also make sure you maintain a good fluid intake (usually 2 1/2 to 3L's a day) which will also help to keep your stools soft.

If your experiencing a lot of pain from these, you can help relieve this with ice. You can do this by adding water to a disposable glove (plastic or latex) and freezing this. Break off the "ice finger" and gently insert it in to the anus.

Anal Fissure

ANAL FISSURES are normally treated with local anaesthetic creams to relieve pain, an ice finger and a haemorrhoid diet as previously described.

If the fissure fails to heal, your doctor can prescribe a nitrate cream to be applied to the area. Rarely, surgical intervention is required such as an anal stretch.

Anal infections

If due to WORM INFECTION, you will need to have a course of Mebendazole or Albendazole. The whole family will need treating at the same time as threadworm is highly infectious, so other family members are also likely to be infected. Failure to treat the "household" will result in reinfection. 

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