What blood in your poo could mean

Seeing red in the toilet bowl can certainly be alarming. If there's blood in your stool, or on the toilet paper, your instinctual response may be to panic. On top of that, embarrassment around the symptom can cause people to steer clear of the GP.

If this has happened to you, the good news is that there are a number of potential culprits, not all of which are cause for concern. The bad news is, you do need to get checked out.

"Seeing blood in the toilet or outside of your stool can often be alarming. However, this is actually quite common and a small amount is not usually a serious problem," says Dr Faiza Khalid, a GP at Medicspot. "It's worth noting that you should not attempt to self-diagnose. If you do think you've seen any bleeding from the bottom, you should see a GP."

As she explains, if the blood is bright red, it may be a sign of haemorrhoids or a small tear (fissure) in the anus. If it's very dark or black, the bleeding has likely happened higher up the digestive tract - it could be due to a stomach ulcer or diverticulitis, or bleeding in the stomach or gut. In either case, it could also be a side effect of blood-thinning medications like aspirin.

"If there's blood in your poo with slime, it could be gastroenteritis, anal fistula, an inflammatory bowel disease, or bowel polyps," she adds. "If you notice blood in your poo with slime, and especially if you also see a change in your pooing habits such as looser poo, diarrhoea or constipation, it could be an early sign of bowel cancer."

Testing for bowel cancer

While bowel cancer is not the most probable cause of bleeding, being aware of the condition can save lives. According to Cancer Research UK, 98% of patients diagnosed at stage I survive for at least one year, compared to just 40% who are diagnosed at stage IV. This means catching it early is critical.

According to Lowri Griffiths, Head of Wales at Bowel Cancer UK, there are five key symptoms that may indicate bowel cancer.

"If you have any kind of bleeding from your bottom, you must go to see your GP because there's something going on, whether it's bowel cancer or another condition," she says.

"But there are other symptoms as well that people need to be aware of. One is that you've had a change in bowel habits lasting three weeks or more. Another is tiredness for no obvious reason; another is being off your food or unexplained weight loss, and the fifth is a pain or lump in your tummy. So if you have any any of those symptoms in combination or alone, or if you don't feel well or feel something's amiss, it's a good idea to get to the doctor."

Once you're there, the doctor will endeavour to build up a picture of what's going on. They are likely to ask you what symptoms you have, when you get them, and whether anything makes them better or worse.

"If necessary, your GP may examine you by checking your bottom with a gloved finger, ask for a sample of poo for testing or refer you to a specialist for further tests," explains Khalid.

These tests may include an endoscopy, in which a small thin tube with a camera is used to look inside the body.

"This could either be a flexible sigmoidoscopy or a full colonoscopy," says Griffiths. "A flexible sigmoidoscopy is where the clinician passes a thin tube up the bottom and halfway up the left side of the bowel. If there's a concern that something's happening further up, they'd refer you for a full colonoscopy where the camera is inserted up the entire length of the bowel. Both of those tests would take place in a hospital setting."

She points out that these tests are nothing to be embarrassed about, and that the doctors administering them perform the procedure every day - usually on many patients every day.

"I think a lot of people are embarrassed by the symptoms and the nature of where the tests are, so they won't go to see the GP. But the procedure can save your life," she says.

Patient picks for Anal and rectal problems

Digestive health

Proctalgia fugax and anal pain

Proctalgia fugax is a fleeting pain in the anus. It lasts less than 20 minutes, with no symptoms whatsoever in between episodes. Levator ani syndrome is a pain which lasts for longer. Both are only diagnosed when no other cause is found.

by Dr Hayley Willacy, FRCGP

Never too young

As a side note, It's important to recognise that, while bowel cancer is more prevalent in older people, younger people can develop the condition too. Around 2,500 people under 50 are diagnosed with bowel cancer in the UK every year, and while that's only 6% of the total, rates among younger people are rising steeply.

Bowel Cancer UK's Never Too Young campaign aims to highlight precisely that, advocating for younger patients and raising awareness of this issue.

"It's vitally important that young people when they have symptoms go to their GP and make sure bowel cancer is ruled out," says Griffiths. "Of course the majority of people who get bowel cancer are older people, but it's something younger people need to be mindful of because they have a bigger challenge getting a diagnosis and that can cause poorer outcomes."

If you are aged between 50 and 75 (Scotland) or 60 and 75 (the rest of the UK), you will be invited for bowel cancer screening every two years, in which a home test is used to look for hidden blood in your poo. If there's a problem, you'll be referred on for further tests, which should flag up anything concerning before it becomes symptomatic.

NHS England is also rolling out bowel scope screening for 55-year-olds. In most, but not all areas, anyone aged 55 is invited to a one-off screening with flexible sigmoidoscopy.

Always get checked out

Of course, in the best-case scenario, it may not be blood in the toilet bowl at all - there could be something much simpler going on.

"Sometimes, if you’ve eaten a lot of red or purple foods like beetroot or tomato, it can look like your poo is mixed with blood. If you take iron tablets or eat a lot of dark foods like black liquorice or Oreo cookies, it can make your poo look very dark or black," points out Khalid.

However, it's best to err on the side of caution and override any embarrassment. If something is amiss, simply visiting the GP and being honest about your symptoms will put you on the right track to sorting it out.