Why does my bum bleed when I wipe?

The most common reason found in studies of people investigated for this is hemorrhoids (swollen veins around the anus), which showed up in about a third of people who had a colonoscopy for rectal bleeding. Less often, the cause was a tumour, bowel inflammation, or nothing visible at all, so it's worth getting checked rather than guessing.

When I wipe my bum I feel a lump — what is that?

No study in this review specifically tracked people who felt a lump when wiping, so there's no solid figure for what it usually turns out to be. Hemorrhoids commonly feel like a lump and are the most frequently found cause of bleeding overall, but a lump alongside bleeding is a reason to have it examined rather than assumed.

Is bright red blood on the paper ever something serious?

Yes, sometimes. Across different studies, a tumour or bowel inflammation explained the bleeding in roughly 1 in 10 to 1 in 40 people investigated, depending on the population studied. Warning signs that make a serious cause more likely include dark red (not bright red) blood, blood mixed into the stool rather than just on the paper, ongoing pain, or unexplained weight loss.

How is blood from hemorrhoids different from blood from cancer?

One review found that bright red surface blood is more typical of hemorrhoids, while dark red blood, persistent anal pain, and unintentional weight loss were flagged as more suggestive of cancer. The same review noted that cancer is sometimes misdiagnosed as hemorrhoids, so these clues help but don't replace an actual exam.

Should I just wait and see if it stops?

No study followed people with unexplained bleeding over time to see how many it resolved on its own, so there's no evidence that waiting is safe. If bleeding continues, keeps coming back, or comes with pain, a lump, or weight loss, have it examined rather than wait.

Why do I bleed bright red blood when I wipe my bum?

Name: Why do I bleed bright red blood when I wipe my bum?
Published: 2026-10-26
Keywords: why does my bum bleed when i wipe, bright red blood when i wipe my butt, when i wipe my bum i feel a lump, red blood when i wipe my bum, why's my bum bleeding when i wipe

In adults who notice bright red blood on toilet paper after a bowel movement, what are the most common causes (e.g. hemorrhoids, anal fissure, polyps, colorectal cancer) and what symptom features help distinguish benign from serious causes?

How people search for this, in their own words

“why does my bum bleed when i wipe”
“bright red blood when i wipe my butt”
“when i wipe my bum i feel a lump”
“red blood when i wipe my bum”
“why's my bum bleeding when i wipe”

Evidence review in plain language · compiled 2026-10-26 · checked 2026-10-26 · next 2026-11-26 · automated review, how it works

Bottom line

Most people who notice bright red blood when they wipe have hemorrhoids or a small tear, but in the one study that checked everyone's true cause with colonoscopy, roughly 1 in 6 people turned out to have something more serious, like a colorectal tumour or bowel inflammation, instead.

In the one study that investigated this exact symptom by colonoscopy, hemorrhoids explained about a third of cases, colorectal tumours about 1 in 11, and inflammatory bowel disease about 1 in 13 — together, about 1 in 6 people had a tumour or bowel inflammation found; roughly 1 in 5 people had no cause found at all [59]. Features like dark (rather than bright) red blood, bleeding that doesn't stop, unexplained weight loss, or persistent pain are flagged in the evidence as more worrying for cancer than for hemorrhoids [4]. Only a couple of studies looked at this exact question directly, so these numbers are a reasonable guide, not a guarantee of what's going on in any one person.

How well studied

Some evidence

Answered by 1 study following patients over time, of limited size or quality.

This question asks why something happens, not whether a treatment works, so there is no benefit-or-harm verdict. What can be shown is how well it has been studied.

answer it directly: 2answer it directly
studies found: 86studies found
randomised trials: 0randomised trials
people studied: 25,759,878people studied
reviews of trials: 3reviews of trials
years covered: 2024–2026years covered

What the research shows

Hemorrhoids as the cause of the bleeding
Across several studies of people investigated for rectal bleeding, hemorrhoids were consistently the single most common cause found, making up roughly a third of cases in one study of outpatients referred for colonoscopy.[1,2,3,4,5]
Some evidence
Anal fissure as the cause
Anal fissures were often lumped together with hemorrhoids in the data rather than reported on their own, so it isn't possible to say how often a fissure specifically explains bright red blood on wiping.[1]
Too little evidence
Colorectal polyps as the cause
Polyps were found at colonoscopy in people with bleeding, including a study of patients with a positive stool screening test who also had bleeding, where large polyps accounted for over half of the significant findings.[1,2]
Some evidence
Colorectal cancer as the cause
Across different study populations, colorectal cancer explained the bleeding in a minority of people: about 1 in 40 (2.5%) among people referred for endoscopy because of rectal bleeding in a large UK registry, and about 1 in 11 (9.3%) among outpatients specifically referred for nonurgent rectal bleeding in a smaller study.[1,2]
Some evidence
A lump you can feel yourself
No study in this review asked people whether they could feel a lump when wiping and then checked what it turned out to be. Hemorrhoids and some tumours can both be felt as a lump, so this symptom alone does not tell you which one you have.
Not studied
Whether colonoscopy or further testing is worthwhile
Studies that actually investigated people with rectal bleeding found a meaningful minority with cancer, bowel inflammation, or large polyps, supporting the value of a proper look rather than assuming hemorrhoids.[1,2,3,4]
Some evidence
Whether bleeding resolves on its own over time
No study in this review followed people with undiagnosed bright red bleeding over time to see how many stopped bleeding without treatment versus kept bleeding. Studies that measured resolution were in people already diagnosed with hemorrhoids and given treatment, not in people whose cause was still unknown.[1,2,3]
Not studied
Red-flag features that point toward a serious cause
One review found that dark red blood, ongoing anal pain, and unexplained weight loss were more often linked to cancer than to hemorrhoids, and that cancer is sometimes mistaken for hemorrhoids because of overlapping symptoms and limited examination.[1,2,3]
Some evidence

What the studies found

In the one study that colonoscoped a large group of outpatients specifically because of rectal bleeding, hemorrhoids were the single most common cause, found in about a third of people.[1]
The same study found no cause at all on colonoscopy in roughly 1 in 5 people, meaning the bleeding may come from something too small or minor to see.[1]
A review comparing hemorrhoids and rectal cancer found that dark red blood, ongoing anal pain, and unintentional weight loss were flagged as warning signs more typical of cancer than of hemorrhoids.[1]
In a study of people who already had a positive bowel cancer screening test plus rectal bleeding, about 1 in 4 had a significant bowel finding on colonoscopy, including cancer, bowel inflammation, or large polyps.[1]

Important limitations

Many of the studies behind these numbers come from hospitals: patients admitted with gastrointestinal bleeding — sometimes severe enough to need a blood transfusion — or people already diagnosed with colorectal cancer, rather than people who simply noticed blood on the paper at home.[1,2,3,4,5,6]
A large share of the evidence describes patients who already have confirmed colorectal cancer and simply notes that some of them also had rectal bleeding. That tells you how common bleeding is among cancer patients, not how common cancer is among people who bleed — the two are not the same question.[1,2,3,4,5,6]
Only one study in this review directly investigated a general group of people with rectal bleeding by colonoscopy and reported what was actually found, and it came from a single pair of hospitals in Iraq, which may not reflect bleeding patterns or causes elsewhere.[1]
Rare but striking causes — melanoma, lymphoma, sarcoma, infections like syphilis or chlamydia, endometriosis, and vascular malformations — appear repeatedly in this evidence because unusual cases get written up and published, not because they are common explanations for blood on the paper.[1,2,3,4,5,6,7,8,9]

What kind of studies

Case series45 · 52%
Retrospective27 · 31%
Narrative review5 · 6%
Case-control3 · 3%
Systematic review2 · 2%
Laboratory study1 · 1%
Prospective cohort1 · 1%
Meta-analysis1 · 1%
Registry1 · 1%

The key studies

Tu et al. 2026
Hemorrhoids and Rectal Cancer: A Systematic Review of Clinical Overlap, Diagnostic Misclassification, and Early Detection Strategies for Primary Care
Usually hemorrhoids; dark blood or pain may mean cancer.Systematic reviewModerate qualityRelated question
46 people2026
Rectal bleeding was the most common symptom shared by hemorrhoids and rectal cancer; dark red blood, persistent anorectal pain, and unexplained weight loss were flagged as warning signs more suggestive of cancer, while misdiagnosis of cancer as hemorrhoids was common due to limited exams and clinical inertia
Who was studied
Adults with anorectal symptoms such as rectal bleeding, change in bowel habits, or anorectal discomfort, mostly seen in primary care
Main outcome
Distinguishing hemorrhoids from rectal cancer when symptoms (especially rectal bleeding) overlap
Quality
It pools 46 studies of mixed designs using only narrative (not statistical) synthesis, and the authors themselves note a scarcity of randomized trials and limited primary-care-specific data.
Limitations
scarcity of randomized controlled trials in diagnostic research, limited primary care data, and preliminary evidence for emerging technologies
Taken word for word from the abstract
- n Forty-six moderate- to high-quality studies were included in the analysis.
- population Hemorrhoidal disease (HD) and rectal cancer (RC) are common anorectal disorders with overlapping clinical symptoms, including rectal bleeding, altered bowel habits, and anorectal discomfort.
- primaryOutcome This systematic review aimed to summarize overlapping features, analyze causes of misdiagnosis, and review advances in early detection to provide practical guidance for primary care.
- result Rectal bleeding was the most frequent overlapping symptom, followed by altered bowel habits and anorectal discomfort. Warning signs suggestive of RC included dark red blood per rectum, persistent anorectal pain, and unexplained weight loss.
- result Major causes of misdiagnosis include clinical inertia, insufficient use of digital rectal examination, and limited access to endoscopy, especially in primary care settings.
J Multidiscip Healthc · PMID 42699804 · Read it on PubMed ↗
Brown et al. 2026
Primary anorectal melanotic melanoma: a case report
Rare cause: anal melanomaCase seriesVery low quality
1 peopleabout 2 years
Bleeding was caused by a rare anorectal melanoma, found as a darkly pigmented mass on colonoscopy
Who was studied
a 71-year-old man who noticed more frequent bright red blood after bowel movements
Main outcome
underlying cause of bright red rectal bleeding found on colonoscopy
Quality
This is a single patient case report, so it cannot tell us how common this cause is, only that it is possible.
Limitations
Single case report; cannot estimate how often this rare cause explains bright red bleeding in the general population.
Taken word for word from the abstract
- population a 71-year-old white male who was referred to gastroenterology after noticing increased frequency of bright red blood per rectum following bowel movements
- primaryOutcome A subsequent colonoscopy revealed a 1.5-cm darkly pigmented, irregular mass in the anorectal region.
- result A diagnosis of anorectal melanoma was confirmed with positive immunohistochemical staining for S-100, HMB45, and Melan-A.
- n a 71-year-old white male
- followUp Follow-up evaluations over about 2 years have shown no evidence of recurrence.
J Med Case Rep · PMID 42310798 · Read it on PubMed ↗
Onem et al. 2026
Effects of age and drug use on lower gastrointestinal bleeding: a retrospective single-center experience
Hemorrhoids common cause in younger bleedersRetrospectiveLow qualityRelated question
181 people30 days
In older patients, colonic diverticula was the commonest cause of bleeding (39%); in younger patients hemorrhoids/anal fissures was commonest (35%). Older patients had higher 30-day mortality, more transfusions, and longer hospital stays. Blood-thinning medication use did not significantly change mortality, need for surgery, transfusion amounts, or length of stay in older patients.
Who was studied
Adults admitted to hospital emergency department with lower gastrointestinal bleeding, split into under-65 and 65-and-older groups
Main outcome
30-day death rate and effect of age and anticoagulant/antiplatelet/NSAID medication use on bleeding outcomes
Quality
Single-center retrospective chart review of hospitalized bleeding patients, which cannot reliably show what causes bleeding in people who are not admitted to hospital.
Limitations
Retrospective single-center design; population is hospitalized emergency department patients with lower GI bleeding severe enough to need admission, not outpatient people simply noticing blood on wiping.
Taken word for word from the abstract
- population A retrospective cohort analysis was conducted on patients with lower gastrointestinal bleeding who were admitted to the emergency department at a single tertiary referral center.
- n A total of 181 patients were retrospectively reviewed.
- primaryOutcome The primary endpoint of the study is to examine the effect of age and medication use on 30-day mortality
- result The most common cause of bleeding in geriatric patients is colonic diverticula (39%), while in the other group it is hemorrhoids/anal fissures (35%).
- result In geriatric patients, medication history did not affect endoscopic treatment, 30-day mortality, surgical needs, the number and amount of transfusions, or length of hospital stay.
BMC Gastroenterol · PMID 41652336 · Read it on PubMed ↗
Hoang et al. 2025
Clinical Characteristics, Interventions and Adverse Outcomes of Acute Lower Gastrointestinal Bleeding: A Cohort Study Conducted in Vietnam
Hemorrhoids common cause of severe bleedingRetrospectiveLow qualityRelated question
222 people2025
Hemorrhoids were the most common identified cause of acute lower GI bleeding (20.7%), followed by diverticulosis (20.3%); many patients needed blood transfusion, endoscopy, or surgery, and 26.6% had severe bleeding
Who was studied
Adults over 18 hospitalized with acute lower gastrointestinal bleeding (bright red blood, maroon stool, or clots) in Vietnam
Main outcome
Causes, treatments, and outcomes of acute lower gastrointestinal bleeding requiring hospital admission
Quality
Single hospital cohort of severely bleeding inpatients, not people with the mild wiping-blood symptom the question is about, so it can't be weighted heavily for this question.
Limitations
Single-center cohort of hospitalized patients with acute, often severe bleeding requiring transfusion or intervention, not outpatients noticing blood on wiping; mixed retrospective/prospective design.
Taken word for word from the abstract
- population 222 patients aged 18 years and older with ALGIB at the Department of Gastroenterology, University Medical Center Ho Chi Minh City
- primaryOutcome This study aims to characterize the presentation, treatment, and outcomes of ALGIB in Vietnamese patients.
- result The most common causes of acute lower gastrointestinal bleeding were hemorrhoids (20.7%) and colonic diverticulosis (20.3%).
- result Severe lower gastrointestinal bleeding was observed in 59 patients (26.6%).
- n A total of 222 patients were included in the study
JGH Open · PMID 40756100 · Read it on PubMed ↗
Haweizy et al. 2024
The Value of Colonoscopy in Assessing Rectal Bleeding in Patients Referred From Outpatient Care Units in Erbil, Iraq
Hemorrhoids are the most common causeRetrospectiveModerate quality
400 people2024
Hemorrhoids were the most common cause of bleeding (35%), followed by colorectal tumors (9.3%) and inflammatory bowel disease (7.8%); about one-fifth of patients had normal colonoscopy findings.
Who was studied
outpatients with nonurgent rectal bleeding referred for colonoscopy
Main outcome
the cause of rectal bleeding identified on colonoscopy
Quality
A reasonably large sample of 400 patients gives useful data, but it is a single-center, cross-sectional review of colonoscopy findings with likely referral bias and no control group.
Limitations
Single-center study from two hospitals in Erbil, Iraq; excluded patients with upper GI bleeding sources, which may limit how well findings apply elsewhere.
Taken word for word from the abstract
- population outpatients who had nonurgent rectal bleeding
- n The total number of patients was 400.
- primaryOutcome identify common pathologies causing rectal bleeding in patients at Erbil and Rizgary Teaching Hospitals in Iraq
- result the highest proportion of the diagnoses was hemorrhoids, either alone (n = 140, 35%) or in combination with other diseases
- result The next two prevalent diagnoses in the total sample were inflammatory bowel disease (n = 31, 7.8%) and colorectal tumor (n = 37, 9.3%).
- result It was observed that around one-fifth (n = 79, 19.8%) of the sample was normal.
Cureus · PMID 39564041 · Read it on PubMed ↗
Attia et al. 2024
Assessing the Role of Flexible Sigmoidoscopy for Patients With Positive Fecal Immunochemical Test (FIT) and Rectal Bleeding as a Sole Symptom Within the Fast-Track Pathway
About a quarter had a serious bowel causeRetrospectiveLow qualityRelated question
344 people2024
25.9% of patients had a significant bowel problem - 18% of those were cancer, 23.6% were inflammatory bowel disease, and 58.4% were large polyps; all cancers and IBD cases were in the lower part of the colon near the rectum
Who was studied
adults referred to a fast-track hospital pathway because they had a positive bowel-cancer screening test (FIT) and rectal bleeding as their only symptom
Main outcome
finding a significant bowel problem (cancer, inflammatory bowel disease, or large polyps) on colonoscopy
Quality
it is a retrospective single-centre review of a specially selected group already flagged as higher-risk by a positive cancer screening test, so it does not reflect ordinary people who simply notice blood on wiping
Limitations
retrospective record review from one hospital trust; population was pre-selected as FIT-positive and referred on a suspected-cancer pathway, not people with plain bright red bleeding of unknown cause; does not describe the appearance or colour of the blood
Taken word for word from the abstract
- population patients with isolated rectal bleeding and a positive FIT result, referred to the 2WW pathway
- n We reviewed records of 344 patients with isolated rectal bleeding and a positive FIT result
- primaryOutcome Significant bowel pathology (SBP) was identified in 89 of 344 (25.9%) patients
- result Significant bowel pathology (SBP) was identified in 89 of 344 (25.9%) patients, including 16 (18%) patients with cancer, 21 (23.6%) patients with IBD, and 52 (58.4%) patients with large polyps. All cases of cancer and IBD were found distal to the splenic flexure
Cureus · PMID 39391448 · Read it on PubMed ↗
Beaton et al. 2024
Diagnostic yield from symptomatic lower gastrointestinal endoscopy in the UK: A British Society of Gastroenterology analysis using data from the National Endoscopy Database
Bleeding is usually not cancerRegistryModerate qualityRelated question
384,510 people2024
Among people referred for endoscopy because of rectal bleeding, cancer was found in 2.5% and this was one of the higher-yield symptoms, but most lower-GI endoscopies were done for low-risk symptoms with a cancer risk close to that of the general population
Who was studied
adults in the UK referred for a colonoscopy or sigmoidoscopy because of symptoms such as rectal bleeding or anaemia
Main outcome
how often colonoscopy or sigmoidoscopy found cancer or large polyps, by symptom
Quality
it is a very large national database analysis, but it only includes people who were already referred for and underwent endoscopy, not the wider population of people who simply notice blood on wiping, so it cannot show how often such bleeding is due to piles versus something serious.
Limitations
Cross-sectional registry data limited to those already selected for endoscopy; does not separate bright-red bleeding noticed on wiping from other patterns of bleeding, and does not look at haemorrhoids as a cause.
Taken word for word from the abstract
- population We analysed 384,510 LGIEs; 33.2% were performed on patients aged under 50 and 53.6% on women.
- primaryOutcome To determine the diagnostic outcomes of LGIE for common symptoms.
- result The highest colonoscopy cancer aPPVs were in the over 50s (1.9%) and in those with rectal bleeding (2.5%) or anaemia (2.1%).
- result Most colonoscopies were performed on patients with low-risk symptoms, where cancer risk was similar to the general population.
- n We analysed 384,510 LGIEs
Aliment Pharmacol Ther · PMID 38634291 · Read it on PubMed ↗

What actually helps, on this site

More about the condition:

All 86 studiesEvery study that answered the question, with its design, size and result.

The other 79 studiesEverything else the search returned, including anything retracted.

Obata et al. 2026
Diffuse Cavernous Hemangioma of the Rectum Diagnosed after a 15-year History of Recurrent Gastrointestinal Bleeding: A Case Report
Rare blood-vessel tumor caused bleeding.Case seriesVery low qualityRelated question
1 people8 months
the bleeding was caused by a rare vascular lesion called diffuse cavernous hemangioma of the rectum, which was surgically removed
Who was studied
a 26-year-old woman with recurrent painless rectal bleeding on defecation since childhood
Main outcome
cause of long-standing rectal bleeding
Quality
this is a single patient case report, so it cannot show how common this cause is among people who notice blood on wiping.
Limitations
Single case of a very rare vascular malformation diagnosed after 15 years of symptoms; not representative of typical patients presenting with bright red blood on wiping of undetermined cause.
Taken word for word from the abstract
- population A 26-year-old woman was referred to our institution for the evaluation of microcytic anemia and recurrent painless hematochezia associated with defecation since childhood, persisting for over 15 years.
- primaryOutcome leading to a diagnosis of DCHR
- result Laparoscopic intersphincteric resection (Lap-ISR) with a diverting loop ileostomy was performed
- result neither hematochezia nor anemia has recurred
- n A 26-year-old woman was referred to our institution
Case Rep Gastroenterol · PMID 42924076 · Read it on PubMed ↗
Tsubokawa et al. 2026
A Case of Diversion Colitis Successfully Treated by Synbiotic Stimulation via the Efferent Limb
Case report, not about this symptomCase seriesVery low qualityRelated question
1 people1 month
follow-up colonoscopy one month later showed marked improvement in the mucosal inflammation
Who was studied
a 75-year-old man with diversion colitis after emergency ileostomy following a colon perforation
What they received
synbiotic stimulation given through the unused (efferent) limb of the ileostomy
Main outcome
improvement in the inflamed, excluded bowel segment seen on repeat colonoscopy
Quality
this is a single case report with no control group, so it cannot show whether the treatment caused the improvement.
Limitations
only one patient, no comparator, and the condition studied (diversion colitis in a surgical stoma) is a specific post-surgical complication, not an undiagnosed case of bright red bleeding on wiping in a general adult.
Taken word for word from the abstract
- population A 75-year-old man underwent endoscopic mucosal resection (EMR) for a transverse colon polyp.
- intervention synbiotic stimulation was administered anterogradely via the efferent limb of the stoma
- primaryOutcome Follow-up colonoscopy performed 1 month later demonstrated marked improvement in the mucosal findings.
- result Follow-up colonoscopy performed 1 month later demonstrated marked improvement in the mucosal findings.
- n A 75-year-old man underwent endoscopic mucosal resection (EMR) for a transverse colon polyp.
Case Rep Surg · PMID 42923604 · Read it on PubMed ↗
Polo et al. 2026
Conserved Epithelial Remodeling Programs Underlie Pediatric Juvenile Colorectal Polyps Associated with Allergic Sensitization
Gene changes found in children's polyps.Laboratory studyLow qualityRelated question
8 people2026
Polyp tissue showed strong activation of allergy-type inflammation genes, loss of normal gut lining genes, and weakened barrier genes, with some gene patterns also seen in colon cancer
Who was studied
Children with juvenile colorectal polyps who had rectal bleeding and allergy-related (IgE) sensitization to foods
Compared with
Paired normal-looking tissue next to the polyp in the same children
Main outcome
Differences in gene activity (RNA sequencing) between polyp tissue and nearby normal tissue
Quality
This is a small laboratory gene-expression study in children with an already-diagnosed structural cause of bleeding (polyps), so it says little about why an adult notices blood on wiping with no known cause.
Limitations
Very small sample (8 polyp samples, 7 paired tissue samples), pediatric population with a specific diagnosed lesion (juvenile polyps), molecular/mechanistic focus rather than a clinical study of unexplained bright red rectal bleeding in adults.
Taken word for word from the abstract
- population Whole-transcriptome RNA sequencing (RNA-seq) was performed on epithelial cells isolated from pediatric JP (n = 8) and paired tissue circumjacent to polyp (TCP) (n = 7) obtained from children with a history of rectal bleeding and IgE sensitization to food allergens.
- comparator paired tissue circumjacent to polyp (TCP) (n = 7)
- primaryOutcome Differential expression, functional enrichment (GO, KEGG, GSEA), and cross-dataset comparison with TCGA colorectal adenocarcinoma (CRC) was conducted.
- result JP epithelium displayed a coherent type 2 inflammatory signature, encompassing upregulation of the alarmin IL33, eosinophil-attracting chemokines (CCL11, CCL24), IgE receptor subunits (FCER1A, FCER1G), and a coordinately activated leukotriene and prostaglandin biosynthetic program (ALOX5, ALOX5AP, PTGS2).
- n pediatric JP (n = 8) and paired tissue circumjacent to polyp (TCP) (n = 7)
Int J Mol Sci · PMID 42737845 · Read it on PubMed ↗
Kpossou et al. 2025
[Colorectal Cancers In Two Hospitals In Cotonou From 2013 To 2023: Epidemiological, Diagnostic, Therapeutic And Prognostic Aspects]
In cancer patients, bleeding was commonRetrospectiveLow qualityRelated question
194 people2025
hematochezia (rectal bleeding) was reported as a symptom in 61.8% of the colorectal cancer patients studied, alongside constipation and abdominal pain; the study did not examine bright red bleeding on wiping as a standalone symptom or its causes in people without a cancer diagnosis
Who was studied
patients diagnosed with colorectal cancer at specialist hospitals in Cotonou, Benin
Main outcome
epidemiological, diagnostic, treatment and survival patterns in colorectal cancer patients
Quality
this is a retrospective hospital record review of patients already diagnosed with colorectal cancer, so it cannot tell us how often bright red bleeding on wiping in a general or undiagnosed population is due to this or other causes
Limitations
retrospective design, restricted to patients already diagnosed with colorectal cancer in specialist cancer-care services, no comparison group of people with undiagnosed bleeding, and no breakdown of bleeding as isolated surface/wiping blood versus bleeding mixed in stool
Taken word for word from the abstract
- population patients with CRC treated in specialized services in Cotonou (CU-CV, CU-MI, CU-HGE, CCC)
- n a total of 194 cases of CRC were recorded out of 13,857 patients (1.4%) seen during the study period
- primaryOutcome We aimed to study the epidemiological, diagnostic, therapeutic, and prognostic aspects of CRC from 2013 to 2023
- result Constipation (78.8%), abdominal pain (71.5%), and hematochezia (61.8%) were the most frequent signs.
Mali Med · PMID 42676316 · Read it on PubMed ↗
Grześkiewicz-Szostak et al. 2026
Early-Onset Colorectal Cancer: From Epidemiologic Shift to Life-Course Carcinogenesis and Age-Attuned Care
Rectal bleeding can be an overlooked cancer sign in young adultsNarrative reviewLow qualityRelated question
size not given2026
Rectal bleeding, along with abdominal pain, altered bowel habits and anaemia, is a common alarm symptom in early-onset colorectal cancer, but it is often underestimated in younger adults, leading to diagnostic delay
Who was studied
Adults already diagnosed with early-onset colorectal cancer (diagnosed before age 50)
Main outcome
How early colorectal cancer is recognized and diagnosed, including symptoms like rectal bleeding
Quality
This is a narrative review that synthesizes other researchers' findings rather than presenting new data specifically on the causes of bright red rectal bleeding in people with undiagnosed symptoms.
Limitations
The review discusses rectal bleeding only as one alarm symptom among several in people already found to have colorectal cancer; it does not study the broader population of people who notice bright red blood on wiping with an undetermined cause.
Taken word for word from the abstract
- population Early-Onset Colorectal Cancer (EOCRC), conventionally defined as colorectal cancer diagnosed before the age of 50 years
- primaryOutcome diagnostic delay, screening limitations, treatment considerations, and survivorship needs
- result recent clinical studies show that EOCRC is frequently symptomatic, yet diagnosis is commonly delayed because alarm features such as rectal bleeding, abdominal pain, altered bowel habits, and anaemia are often underestimated in younger adults
Curr Oncol Rep · PMID 42618835 · Read it on PubMed ↗
Pacheco Oliva et al. 2026
Juvenile Polyposis Syndrome in a Post-Fontan Adolescent With Tetralogy of Fallot: A Rare Association With Important Cancer Risk and Developmental Overlap
Rare polyp syndrome caused bleeding, not typical caseCase seriesVery low qualityRelated question
1 people2026
Bleeding was caused by juvenile polyposis syndrome — multiple hamartomatous polyps throughout the colon and stomach, diagnosed by colonoscopy and histology
Who was studied
14-year-old boy with repaired Tetralogy of Fallot and Fontan-type physiology, with intermittent rectal bleeding and poor weight gain
Main outcome
Cause of rectal bleeding (hematochezia) identified via colonoscopy and biopsy
Quality
This is a single pediatric case report in a child with complex congenital heart disease, so it cannot establish why bleeding on wiping happens in typical adults.
Limitations
Single case report in a child with unique congenital heart disease and a rare genetic polyposis syndrome; genetic testing was not available to confirm the diagnosis; not generalizable to adults with isolated bright red rectal bleeding.
Taken word for word from the abstract
- population A 14-year-old adolescent boy with repaired Tetralogy of Fallot and Fontan-type physiology presented with intermittent hematochezia and poor weight gain.
- primaryOutcome Colonoscopy revealed multiple pedunculated polyps throughout the colon, including several larger than 1 cm, and upper endoscopy demonstrated gastric polyposis.
- result Histology confirmed hamartomatous juvenile polyps without dysplasia, fulfilling diagnostic criteria for juvenile polyposis syndrome.
- n A 14-year-old adolescent boy
ACG Case Rep J · PMID 42583663 · Read it on PubMed ↗
Arbabi et al. 2026
Probable Association Between Hidradenitis Suppurativa and Inflammatory Bowel Disease: A Case Report
Several causes found in one complex caseCase seriesVery low qualityRelated question
1 people2026
workup found several possible causes at once: perianal fistulous tracts, large external hemorrhoids, active chronic proctitis with crypt abscess and erosion, and diverticulitis, with features raising concern for underlying inflammatory bowel disease
Who was studied
a 64-year-old man with longstanding hidradenitis suppurativa, chronic colostomy, and multiple other health problems
Main outcome
finding the cause of bright red blood from the rectum
Quality
this is a single complicated patient with many overlapping conditions, so it cannot tell us what usually causes bright red blood on wiping in a typical adult
Limitations
single case report in a patient with unusual combination of hidradenitis suppurativa, colostomy, and multiple comorbidities; not representative of typical patients noticing blood on wiping; focus of the report is the possible HS-IBD link, not explaining the bleeding symptom in general
Taken word for word from the abstract
- population a 64-year-old man with longstanding HS, chronic colostomy, and multiple comorbidities who presented with acute bright red blood per rectum
- primaryOutcome presented with acute bright red blood per rectum
- result Our extensive workup revealed multiple perianal open fistulous tracts with scarring, large external hemorrhoids, active chronic proctitis with focal crypt abscess formation and erosion, and diverticulitis with negative infectious workup.
- n a case of a 64-year-old man
Cureus · PMID 42502566 · Read it on PubMed ↗
García Ramírez et al. 2026
Atypical Gastrointestinal Kaposi Sarcoma With Circumferential Anorectal Involvement in a Young Man With Controlled HIV Infection: A Case Report
Rare case: tumour, not usual causesCase seriesVery low qualityRelated question
1 people2026
Biopsy showed the bleeding was caused by a rare tumour, Kaposi sarcoma, in the rectum and anal canal, not a common cause like haemorrhoids
Who was studied
a 25-year-old man with HIV infection on antiretroviral therapy who had anal pain and rectal bleeding
Main outcome
finding the cause of rectal bleeding and anal pain
Quality
This is a single unusual case in an HIV-positive patient, so it cannot tell us why most people see blood when wiping.
Limitations
Single case report of a rare malignancy in an immunocompromised patient; not representative of typical rectal bleeding seen on wiping.
Taken word for word from the abstract
- population a 25-year-old male with HIV infection on antiretroviral therapy and an undetectable viral load who presented with one month of anal pain and rectal bleeding
- primaryOutcome Initial colonoscopy demonstrated multiple irregular ulcerated lesions in the distal rectum, and biopsy confirmed Kaposi sarcoma associated with human herpesvirus 8
- result biopsy confirmed Kaposi sarcoma associated with human herpesvirus 8
- n a 25-year-old male with HIV infection
Cureus · PMID 42299212 · Read it on PubMed ↗
Dhorajiya et al. 2026
Intestinal spirochetosis in the modern era: a decade-long clinicopathologic study
Mostly unrelated infection finding, not about bleedingRetrospectiveLow qualityRelated question
175 people2026
Most patients had colonoscopy for unexplained diarrhea (48.6%) or cancer screening (36%); only 6.3% had rectal bleeding as the reason for colonoscopy. The condition showed male predominance and affected both healthy and immunosuppressed people, and was symptomatic in about two-thirds of cases.
Who was studied
patients diagnosed with intestinal spirochetosis on colon biopsy over a 10-year period
Main outcome
clinical and pathological features of intestinal spirochetosis, including reasons patients underwent colonoscopy
Quality
This is a retrospective case series of biopsy-diagnosed infection, not a study designed to investigate causes of rectal bleeding, so it offers very limited evidence for this specific question.
Limitations
Single-institution retrospective review; rectal bleeding was the reason for colonoscopy in only a small minority of cases, and the study is about a specific infection (intestinal spirochetosis) found incidentally rather than an investigation into causes of bright red bleeding on wiping.
Taken word for word from the abstract
- population We studied 175 cases of IS diagnosed at our institution over a 10-year period.
- n We studied 175 cases of IS diagnosed at our institution over a 10-year period.
- primaryOutcome The clinicopathologic features were reviewed using hematoxylin and eosin (H&E)-stained slides, along with the results from histochemical and immunohistochemical analyses.
- result Indications for colonoscopy were unexplained diarrhea (48.6%), colorectal cancer screening (36%), rectal bleeding (6.3%), abdominal pain (4%), follow-up for ulcerative colitis (4%), Crohn disease (0.6%), and constipation (0.6%).
- result Intestinal spirochetosis in our study had a striking male predominance and affected both immunocompetent and immunosuppressed individuals.
Am J Clin Pathol · PMID 42289886 · Read it on PubMed ↗
Samaddar et al. 2026
Characterizing symptom patterns in early-onset colorectal cancer: insights from a national inpatient analysis
Bleeding can rarely signal young colon cancerRetrospectiveLow qualityRelated question
18,017 people2026
In this inpatient database study, hematochezia was one of several symptoms (along with constipation and iron-deficiency anemia) that showed a different pattern of association with early-onset versus late-onset colorectal cancer; constipation showed the strongest divergence, especially in women under 40, but absolute cancer rates among symptomatic patients stayed low.
Who was studied
adults hospitalized with colorectal cancer (early-onset vs. late-onset) compared with non-cancer hospitalized controls
Main outcome
which symptoms (including rectal bleeding/hematochezia, constipation, anemia) are associated with a colorectal cancer diagnosis in hospitalized patients
Quality
this is a retrospective analysis of hospitalized patients only, which likely over-represents advanced or complicated cancer and does not include outpatients who simply notice blood on wiping, and the authors themselves caution the absolute cancer risk from these symptoms remained low.
Limitations
Study population is hospitalized colorectal cancer patients identified by ICD-10 codes, not people presenting in primary care with isolated bright red bleeding on wiping and no diagnosis; authors note findings 'reflect hospitalized encounters and may be enriched for patients with more advanced or complicated disease.'
Taken word for word from the abstract
- population Among 18,017 EOCRC hospitalizations, several symptoms demonstrated differential associations compared to LOCRC, including constipation, iron-deficiency anemia, and hematochezia.
- n Among 18,017 EOCRC hospitalizations
- primaryOutcome Symptoms were defined using ICD-10 codes.
- result Constipation showed the strongest divergence between EOCRC and LOCRC (aOR 2.50 vs. 1.12), particularly among women under 40 (aOR 5.72; p < 0.001).
- result Importantly, despite significant relative associations, the absolute prevalence of colorectal cancer among constipation-related hospitalizations remained low, underscoring the need for cautious interpretation and further prospective validation.
- limitations these findings reflect hospitalized encounters and may be enriched for patients with more advanced or complicated disease rather than early-stage detection
Cancer Treat Res Commun · PMID 42287778 · Read it on PubMed ↗
Aksim et al. 2026
Lower Gastrointestinal Bleeding Revealing an Early-Stage Primary Anorectal Melanoma: A Case Report
Rare cause: anorectal melanomaCase seriesVery low qualityRelated question
1 people2026
Counted as a related question: This case report describes a rare cancer diagnosis in one patient with rectal bleeding, not an explanation of why bright red blood appears on wiping in the general adult population experiencing this symptom.
The bleeding turned out to be caused by a rare anorectal melanoma (a cancer), not hemorrhoids, found via colonoscopy and biopsy
Who was studied
A 62-year-old woman having tests to find the cause of mild rectal bleeding, with no other symptoms
Main outcome
The underlying cause of the rectal bleeding
Quality
This is a single patient case report, so it cannot show how common this cause is, only that it is possible.
Limitations
Only one patient; findings from a single rare case cannot be generalised to most people with rectal bleeding.
Taken word for word from the abstract
- population We report the case of a 62-year-old women who presented for an etiological evaluation of mild rectal bleeding without other associated signs.
- primaryOutcome etiological evaluation of mild rectal bleeding without other associated signs
- result The colonoscopy revealed a friable and ulcerated process in the lower and middle rectum, and several biopsies were performed, confirming the diagnosis of rectal melanoma.
- n a 62-year-old women
Gulf J Oncolog · PMID 42274068 · Read it on PubMed ↗
Tran et al. 2026
Rectal Neuroendocrine Tumor Presenting as Refractory Chronic Pruritus Ani: A Case Report
Rare tumor behind itching and bleeding.Case seriesVery low qualityRelated question
1 people2026
endoscopic evaluation led to diagnosis of a rare, early-stage (grade 1) rectal neuroendocrine tumor
Who was studied
a 42-year-old man with ongoing anal itching and mild rectal bleeding that did not respond to usual treatment
Main outcome
finding the cause of persistent anal itching and rectal bleeding
Quality
this is a single patient case report, so it cannot show how common or rare this cause is for people who notice blood on wiping.
Limitations
Only one patient; symptoms were dominated by chronic itching rather than isolated bright red bleeding on wiping, and the underlying cause (a rare tumor) is not representative of the general question.
Taken word for word from the abstract
- population a 42-year-old male with persistent pruritus ani and mild rectal bleeding refractory to conventional treatment
- n a 42-year-old male
- primaryOutcome highlights the critical role of endoscopic evaluation in achieving early diagnosis and favorable outcomes
- result ultimately diagnosed with a well-differentiated grade 1 rectal NET
Case Rep Gastroenterol · PMID 42256648 · Read it on PubMed ↗
Thorsen et al. 2026
Rectal syphilis presenting as a bleeding rectal tumour
Rare case: bleeding mass was syphilis, not cancerCase seriesVery low qualityRelated question
1 people2026
The bleeding rectal mass turned out to be a primary syphilis chancre, not cancer
Who was studied
A man in his 40s referred to hospital for rectal bleeding
Main outcome
Cause of a bleeding rectal mass
Quality
A single case report cannot show how common this cause is or apply to most people who bleed on wiping.
Limitations
Single patient case report; findings cannot be generalised to the broader population of people with rectal bleeding on wiping.
Taken word for word from the abstract
- population A male patient in his 40s was referred to hospital due to rectal bleeding.
- primaryOutcome We present a rare case of a bleeding mass in the rectum.
- result Hence, the rectal tumour was identified as a primary chancre of syphilis.
- n A male patient in his 40s was referred to hospital due to rectal bleeding.
J Surg Case Rep · PMID 42245419 · Read it on PubMed ↗
Thiagarajan et al. 2026
Pedunculated Polypoidal Anal Canal Lymphangioma in an Adult Male: A Report of a Rare Case and Review of the Literature
Rare unrelated tumor, not a bleeding cause.Case seriesVery low qualityRelated question
1 people2026
The polyp was a rare benign lymphatic tumor (lymphangioma), not an explanation for rectal bleeding; this patient did not even present with bleeding
Who was studied
Adult male in his twenties found to have an anal canal lymphangioma (a rare benign tumor), who presented with abdominal bloating rather than bleeding
Main outcome
Cause of an anal canal polyp found on colonoscopy, diagnosed by histopathology and immunohistochemistry
Quality
A single case report of one rare tumor cannot tell us why typical bright red bleeding on wiping happens.
Limitations
Single case report of an extremely rare tumor; patient presented with bloating, not with bleeding on wiping, so it does not address the symptom in question.
Taken word for word from the abstract
- n An adult male in his early twenties presented with complaints of a bloating sensation in his abdomen.
- population An adult male in his early twenties presented with complaints of a bloating sensation in his abdomen.
- primaryOutcome The diagnosis of anal lymphangioma was established and confirmed by IHC with D2-40 and CD31.
- result Unlike common presentations of rectal bleeding or discomfort, our patient reported a bloating sensation.
Cureus · PMID 42037797 · Read it on PubMed ↗
Townsend et al. 2026
Knowledge, Symptom Awareness, and Referral Practices of Primary Care Providers in Early-Onset Colorectal Cancer
Doctors often delay referral for bleedingRetrospectiveLow qualityRelated question
1,490 people2026
Awareness was highest for bowel habit changes (79%) and lowest for abdominal pain (43%); about 45% of providers would refer patients with rectal bleeding to colonoscopy or offer a stool test, with most doing a workup and family history check first rather than immediate referral
Who was studied
Primary care providers practicing in the United States
Main outcome
Awareness of early-onset colorectal cancer symptoms and referral practices for patients under 50
Quality
It is a self-reported survey of doctors' knowledge and intended practices, not a study of patients or of why bleeding occurs.
Limitations
Self-reported survey data on intended practice rather than actual patient outcomes; does not study patients with rectal bleeding or its causes.
Taken word for word from the abstract
- population This survey included 1490 PCPs practicing in the United States.
- n This survey included 1490 PCPs practicing in the United States.
- primaryOutcome The objective of this study was to examine primary care providers' (PCPs') awareness of CRC-related symptoms and their diagnostic approaches for patients under age 50 using the 2023 DocStyles panel survey.
- result Symptom awareness of early-onset CRC was highest for changes in bowel habits (79%) and lowest for abdominal pain (43%).
- result Around 45% of PCPs would refer patients with rectal bleeding/bloody stools to diagnostic colonoscopy or offer a stool-based screening test.
- result Most PCPs would complete a workup and assess patients for family history of cancer for patients presenting with rectal bleeding/bloody stools, iron deficiency anemia, or changes in bowel habits.
Popul Health Manag · PMID 41943394 · Read it on PubMed ↗
Masina et al. 2026
Evaluating clinicopathological pattern and management of colorectal cancer for adult patients presenting at Queen Elizabeth Central Hospital: a 10-year retrospective review
Bleeding common symptom in colorectal cancer patientsRetrospectiveLow qualityRelated question
192 people2026
Rectal bleeding was a symptom in 40.63% of colorectal cancer patients, alongside abdominal pain in 52.08%
Who was studied
Adults diagnosed with colorectal cancer at a hospital in Malawi over 10 years
Main outcome
Pattern of symptoms, diagnosis, and treatment of colorectal cancer
Quality
This is a single-centre retrospective chart review of patients already diagnosed with colorectal cancer, not a study of people with undiagnosed rectal bleeding, so it can't tell us how often bleeding on wiping is due to cancer versus other causes.
Limitations
Retrospective register review with missing histology confirmation in 42.71% of cases and no comparison group of people with undiagnosed bleeding
Taken word for word from the abstract
- n There were 192 patients identified with CRC.
- population adult patients presenting at Queen Elizabeth Central Hospital (QECH), Malawi
- primaryOutcome evaluated clinicopathological pattern and management of CRC
- result Abdominal pain and rectal bleeding were the predominant symptoms occuring in 100 (52.08%) and 78 (40.63%) respectively.
BMC Gastroenterol · PMID 41942892 · Read it on PubMed ↗
Saleh et al. 2026
Rectal predominance and annular wall thickening: Abdominal computed tomography and clinical characteristics of colorectal cancer in a resource-limited setting
Blood on wiping linked to confirmed rectal cancer in this suspected-cancer groupRetrospectiveLow qualityRelated question
60 people2026
Colorectal cancer was confirmed in 56.7% of suspected patients, most often in the rectum with annular wall thickening, and hematochezia was significantly associated with confirmed cases (p = 0.03)
Who was studied
patients suspected of having colorectal cancer who were referred for abdominal CT scans
Main outcome
abdominal CT findings and clinical factors linked to confirmed colorectal cancer
Quality
small single-hospital sample of only 60 patients already suspected of cancer, with the authors themselves calling the associations exploratory
Limitations
small sample size, single center, population pre-selected as suspected CRC rather than general people noticing blood on wiping, associations described as exploratory
Taken word for word from the abstract
- population a cross-sectional, hospital-based study of 60 patients with suspected CRC who were referred to our centre for abdominal CT
- n 60 patients with suspected CRC
- primaryOutcome abdominal CT findings, and histology results were recorded in a structured questionnaire
- result colorectal tumours were confirmed in 56.7%, mostly rectal (26.7%), often with annular thickening (46.7%) and heterogeneous enhancement (43.3%)
- result Significant associations were found with lower education (p = 0.04), alcohol use (p = 0.02), and hematochezia (p = 0.03)
Surg Oncol · PMID 41903361 · Read it on PubMed ↗
Tanrıkulu et al. 2026
Waiting in the Shadows: Diagnostic Delays and Illness Perceptions in Colorectal Cancer Patients
Not about cause of bleeding; studies cancer diagnosis delayRetrospectiveLow qualityRelated question
114 people2026
Patients waited an average of 7.3 months before seeking care; rectal bleeding was one of several reported symptoms (in 15.3% of patients), alongside bowel habit changes, fatigue and abdominal pain; most patients were unaware of colorectal cancer warning signs
Who was studied
Adults already diagnosed with colorectal cancer attending an oncology outpatient clinic
Main outcome
Time from first noticing symptoms to seeking medical care, and factors linked to delay
Quality
This is a single-clinic survey of patients who already had a cancer diagnosis, so it cannot explain why bleeding happens in people whose cause is still unknown.
Limitations
Cross-sectional, single-center, relies on patient recall, and studies only confirmed cancer patients rather than people with undiagnosed rectal bleeding
Taken word for word from the abstract
- population 114 patients with colorectal cancer
- primaryOutcome determine the time between the onset of initial symptoms and the decision to seek medical help
- result The mean time from symptom onset to seeking medical help was 7.3 ± 11.0 months
- result rectal bleeding (15.3%)
- n included 114 patients with colorectal cancer
Semin Oncol Nurs · PMID 41832104 · Read it on PubMed ↗
Pereira et al. 2026
CHANGING PATTERNS IN THE EPIDEMIOLOGY OF ACUTEGASTROINTESTINAL BLEEDING IN BRAZIL OVER THE LAST 12 YEARS
Hemorrhoids one of many hospital bleeding causes.RetrospectiveLow qualityRelated question
2,145 people2026
the most common causes of lower GI bleeding were colonic diverticular disease, radiation-related proctocolitis, and hemorrhoids, while upper GI bleeding was mostly from varices and ulcers; death rates fell over the study period
Who was studied
adults hospitalized with gastrointestinal bleeding at a tertiary hospital in Brazil
Main outcome
causes of GI bleeding and in-hospital death rates
Quality
this is a single-center retrospective chart review of hospitalized bleeding patients, not a study of outpatients who simply notice blood on wiping, so it can only weakly inform this question.
Limitations
retrospective design, single hospital, and population is hospitalized patients with gastrointestinal bleeding severe enough to need admission, not people presenting with isolated bright red blood on wiping
Taken word for word from the abstract
- population All patients admitted to the Gastrointestinal (GI) Unit of the Portuguese Hospital of Salvador, Bahia, Brazil with the diagnosis of GIB between January 2012 and December 2023 were retrospectively investigated.
- n 2.145 patients (1.214 males, mean age 70+16 years) were admitted, 1.185 in period 1 and 960 in period 2.
- primaryOutcome To investigate the main causes and mortality of patients admitted to a tertiary care hospital in Brazil with UGIB and LGIB, as well as to assess trends in epidemiology and outcomes of GIB over time.
- result The most common etiologies for UGIB and LGIB were, respectively, esophagogastric varices (EV), duodenal (DU) and gastric ulcer (GU), and colonic diverticular disease (CDD), actinic proctocolitis (APC) and hemorrhoids (HE).
- result a significant decrease in mortality in recent years (14,2% vs 10.1% of deaths in period 2, P=0.005)
Arq Gastroenterol · PMID 41779539 · Read it on PubMed ↗
Elhoseeny et al. 2026
Bleeding rectal polyp as an atypical presentation of intestinal schistosomiasis: A case report from Egypt
Rare parasite caused a bleeding polypCase seriesVery low qualityRelated question
1 people2026
A solitary ulcerated rectal polyp caused the bleeding, and biopsy showed it was due to intestinal schistosomiasis (a parasitic infection), not a tumor or IBD
Who was studied
28-year-old man from rural Egypt with rectal bleeding and abdominal pain
Main outcome
underlying cause of rectal bleeding
Quality
This is a single unusual case report, so it cannot show how common this cause is or apply to most people with this symptom.
Limitations
Single case from a region where schistosomiasis is common; stool tests for the parasite were repeatedly negative, showing this cause can be easily missed or may not reflect typical bleeding causes elsewhere.
Taken word for word from the abstract
- n A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding.
- population A 28-year-old Egyptian male from a rural area presented with a 3-month history of intermittent lower abdominal pain and rectal bleeding.
- primaryOutcome Colonoscopy identified a solitary, pedunculated, and ulcerated rectal polyp (1.5 × 3.0 cm) at 20 cm from the anal verge, which was completely resected.
- result Histopathological examination confirmed the diagnosis by demonstrating viable Schistosoma mansoni ova within eosinophilic granulomas and, critically, an adult worm residing in the submucosal vasculature, confirming active infection.
- result notably, stool microscopy was repeatedly negative for schistosome ova, despite the presence of RBCs and WBCs
PLoS Negl Trop Dis · PMID 41662285 · Read it on PubMed ↗
Zhang et al. 2026
Human Intestinal Spirochetosis as a Cause of Chronic Diarrhea in an Immunocompetent Patient: A Case Report
Rare gut infection caused diarrhea, not bleeding.Case seriesVery low qualityRelated question
1 people2026
The patient was treated with a 10-day course of metronidazole and had complete remission of diarrhea after being diagnosed with Human Intestinal Spirochetosis via colonoscopy biopsy
Who was studied
immunocompetent patient with chronic watery diarrhea and weight loss
What they received
metronidazole treatment for Human Intestinal Spirochetosis
Compared with
none (single case, before/after treatment)
Main outcome
resolution of diarrhea after treatment
Quality
This is a single case report of one patient with chronic diarrhea, not a study of people with bright red rectal bleeding on wiping, so it cannot establish why that symptom occurs.
Limitations
Single case report; patient's main presenting symptom was chronic diarrhea and weight loss, not bright red blood on wiping; rectal bleeding is only mentioned as a rare possible feature of this rare infection in general, not something this patient experienced.
Taken word for word from the abstract
- population an immunocompetent patient without risk factors presented with chronic watery diarrhea and unintentional weight loss of 3.18 kilograms after two months
- intervention The patient was treated with a 10-day course of metronidazole (500 mg, three times a day)
- comparator with complete remission of diarrhea
- primaryOutcome with complete remission of diarrhea
- result HIS was confirmed by biopsy through colonoscopy. The patient was treated with a 10-day course of metronidazole (500 mg, three times a day) with complete remission of diarrhea.
- n an immunocompetent patient without risk factors presented with chronic watery diarrhea
Cureus · PMID 41658837 · Read it on PubMed ↗
Takahashi et al. 2026
Uncommon cause of hematochezia in older adults: a solitary juvenile polyp in the transverse colon
Rare colon polyp caused bleedingCase seriesVery low qualityRelated question
1 people2026
a 12 mm juvenile polyp in the transverse colon was found and removed, and bleeding did not recur
Who was studied
78-year-old woman with rectal bleeding (hematochezia)
Main outcome
identifying the cause of the bleeding
Quality
this is a single case report, so it cannot show how common this cause is or apply to most people with this symptom
Limitations
single patient; describes hematochezia from a deep colonic lesion found at colonoscopy, not specifically blood noticed on wiping with an undetermined cause; a rare diagnosis unlikely to represent typical cases
Taken word for word from the abstract
- population A 78-year-old woman presented with hematochezia.
- primaryOutcome To report a rare case of a solitary juvenile polyp in the transverse colon causing hematochezia in an older patient.
- result Colonoscopy performed at a local hospital revealed a 12 mm pedunculated lesion in the transverse colon covered with fresh blood.
- result The patient remained asymptomatic after the procedure and experienced no recurrence of bleeding.
- n A 78-year-old woman presented with hematochezia.
J Rural Med · PMID 41568119 · Read it on PubMed ↗
Fujino et al. 2025
Behavioral changes and delayed colorectal cancer diagnosis during COVID-19: a real-world survey analysis
Delayed diagnosis tied to pandemic changesRetrospectiveLow qualityRelated question
83 people2025
Rectal bleeding was reported more often as a symptom later in the pandemic period, and patients who delayed care tended to be diagnosed with more advanced cancer, but the study does not explain why bright red bleeding on wiping occurs
Who was studied
patients who had already had surgery for colorectal cancer, surveyed about their symptoms and health-care visits during the COVID pandemic
Main outcome
whether pandemic-related delays in medical visits and screening affected cancer diagnosis and stage, with rectal bleeding noted as a presenting symptom
Quality
This is a small retrospective survey of only 83 patients already diagnosed with colorectal cancer, looking at pandemic-related delays rather than the cause of rectal bleeding itself, and one key association was not statistically significant (P = 0.062).
Limitations
Small sample, survey-based and retrospective design, population already had confirmed colorectal cancer rather than undiagnosed rectal bleeding, so it does not address the everyday causes of bright red blood on wiping.
Taken word for word from the abstract
- n Among the 98 patients who completed the survey, 83 met the inclusion criteria
- population patients who underwent colorectal cancer surgery at Osaka University Hospital and Minoh City Hospital between January 2021 and June 2023
- primaryOutcome Clinical symptoms, particularly rectal bleeding, were more common in the latter part of the study period (P = 0.014).
- result the disease stage tended to be more advanced in patients who changed their behavior (P = 0.062)
BMC Gastroenterol · PMID 41390368 · Read it on PubMed ↗
Castro et al. 2026
Uncovering the Red Flags: A Cross-Sectional Retrospective Case-Control Study on Predictors of Early-Onset Colorectal Cancer in a Multistate Community Health System
Bleeding is one of several cancer risk flagsCase-controlLow qualityRelated question
2,052 people2026
rectal bleeding, along with abdominal pain, constipation, iron deficiency anemia, alcohol use, more health conditions, and certain medications, was linked to higher odds of having early-onset colorectal cancer
Who was studied
adults aged 20 to 49 diagnosed with early-onset colorectal cancer, compared to matched controls without it
Main outcome
factors associated with being diagnosed with early-onset colorectal cancer
Quality
this is a retrospective records-based case-control study comparing people already diagnosed with colorectal cancer to matched controls, not a study of people presenting with bright red bleeding on wiping to find its cause, so it cannot say how likely cancer is among such people.
Limitations
Retrospective electronic record review restricted to one multistate health system with mostly White, non-Hispanic patients; compares pre-diagnosed cancer cases to controls rather than studying undiagnosed people presenting with the symptom.
Taken word for word from the abstract
- population we compared adults ages 20 to 49 years diagnosed with EOCRC (2017-2023) to control patients without EOCRC who were 1:2 exact-matched based on age and sex
- primaryOutcome we analyzed data with univariate then multivariate logistic regressions to predict the odds of EOCRC diagnosis
- result several predictors were significantly associated with higher EOCRC odds, including alcohol use history, higher number of comorbidities, abdominal pain, rectal bleeding, constipation, iron deficiency anemia, and prescriptions for metformin, non-steroidal anti-inflammatory drugs (NSAID), and multivitamins
- n Our final analysis included 684 EOCRC cases and 1,368 controls.
Cancer Prev Res (Phila) · PMID 41384824 · Read it on PubMed ↗
De León Murillo et al. 2025
The Altemeier Procedure in the Management of Rectal Prolapse Secondary to a Prolapsed Rectal Polyp: A Valid Alternative
Rare cause: prolapsed rectal polyp.Case seriesVery low qualityRelated question
1 people2025
A giant adenomatous rectal polyp caused rectal prolapse and bleeding; it was treated surgically with good recovery
Who was studied
A 67-year-old woman with a rectal polyp who had rectal bleeding and rectal prolapse
Main outcome
Identifying the cause of rectal bleeding and prolapse, and surgical management
Quality
This is a single patient case report, so it cannot show how common this cause is or apply to people in general.
Limitations
Single case report in a patient with a known, diagnosed rectal polyp and prolapse, not people with undiagnosed bright red bleeding on wiping.
Taken word for word from the abstract
- population a 67-year-old female patient with a history of a rectal polyp, who sought consultation for rectal bleeding and rectal prolapse
- primaryOutcome A giant rectal polyp was documented as the main cause of the prolapse
- result A giant rectal polyp was documented as the main cause of the prolapse, which was managed surgically with a perineal rectosigmoidectomy (Altemeier procedure).
- n a 67-year-old female patient
Cureus · PMID 41356851 · Read it on PubMed ↗
Adetiloye et al. 2025
A Rare Diagnosis of HPV-Positive Rectal Squamous Cell Carcinoma in a 59-Year-Old Heterosexual Woman: Implications for Screening Guidelines
Bleeding caused by rare HPV-linked rectal cancerCase seriesVery low qualityRelated question
1 people2025
Histopathological analysis confirmed invasive rectal SCC, with strong immunohistochemical staining for squamous markers. High-risk HPV subtypes 16, 18, and 33 were detected.
Who was studied
a 59-year-old heterosexual woman with no history of anal cancer, immunosuppression, or other established risk factors
Main outcome
cause of intermittent rectal bleeding and bowel habit changes
Quality
This is a single case report of one rare patient, so it cannot tell us how common this cause is for people who notice blood on wiping.
Limitations
Single case report describing an unusual presentation in one patient with no typical risk factors, not a study of the general population who notice rectal bleeding on wiping.
Taken word for word from the abstract
- population a 59-year-old heterosexual woman with no history of anal cancer, immunosuppression, or other established risk factors
- primaryOutcome The patient exhibited intermittent rectal bleeding and recent changes in bowel habits.
- result Histopathological analysis confirmed invasive rectal SCC, with strong immunohistochemical staining for squamous markers. High-risk HPV subtypes 16, 18, and 33 were detected.
- n a 59-year-old heterosexual woman
Am J Case Rep · PMID 41196829 · Read it on PubMed ↗
Yamada et al. 2026
PEComas of the colon and rectum: a case report of a 15-year-old girl and a review of the pertinent literature
Rare tumor found as cause in one case.Case seriesVery low qualityRelated question
1 peoplefive years postoperatively
a rare tumor called PEComa-NOS was found in the rectum and removed surgically, with no recurrence after five years
Who was studied
a 15-year-old girl who had rectal bleeding (hematochezia)
Main outcome
the cause of the rectal bleeding (hematochezia) found at colonoscopy
Quality
this is a single patient case report, so it cannot show how common this cause is for people who notice blood on wiping
Limitations
single case, rare tumor diagnosis, not representative of typical causes of bright red rectal bleeding
Taken word for word from the abstract
- population A 15-year-old girl underwent a colonoscopy due to hematochezia
- primaryOutcome thus revealing a 30 mm intramural mass in the upper rectum
- result Histologically the tumor was positive for HMB45 (human melanoma black 45), TFE3 (transcription factor binding to IGHM enhancer 3), which suggested the diagnosis of PEComa-NOS.
- result The patient remains recurrence-free at five years postoperatively.
- n A 15-year-old girl underwent a colonoscopy due to hematochezia
Clin J Gastroenterol · PMID 41182504 · Read it on PubMed ↗
Abu-Freha et al. 2026
Clinical characteristics and outcomes of colorectal cancer in elderly patients, insights from a large database in Israel
Bleeding less common in elderly cancer patientsRetrospectiveLow qualityRelated question
68,059 people2026
Rectal bleeding was a less common presenting symptom in older (over 75) colorectal cancer patients compared with younger patients, while anemia, constipation, and weight loss were more common presenting symptoms in the elderly group
Who was studied
Patients diagnosed with colorectal cancer, comparing those over age 75 to younger patients, using a national health database and a single-center cohort
Main outcome
Clinical and endoscopic characteristics of colorectal cancer patients, including presenting symptoms such as rectal bleeding
Quality
It is a retrospective database comparison of patients already diagnosed with colorectal cancer, so it cannot tell us about the many other causes of bright red bleeding in people without cancer, and the two groups differ in many ways besides age.
Limitations
Retrospective design; compares two differently defined cohorts (national database vs single tertiary center); population is restricted to confirmed colorectal cancer patients, not people with undiagnosed rectal bleeding.
Taken word for word from the abstract
- n A total of 27 465 patients in the LOCRC group were compared with 40 594 younger patients.
- population We included patients with confirmed colorectal cancer (CRC) diagnosis in a national cohort from a large health service provider (Clalit), and a local cohort in a single tertiary center
- primaryOutcome We collected data regarding demographics, indications, comorbidities, endoscopic data, and laboratory values.
- result rectal bleeding was a less common indication in patients with LOCRC (15.4 vs. 21%), while constipation (18.2 vs.8.4%), anemia (28.3 vs 13.4%), and weight loss (13.8 vs. 7.4%) were more prevalent.
Eur J Cancer Prev · PMID 41117609 · Read it on PubMed ↗
Jøhnk et al. 2026
Healthcare seeking with colorectal cancer symptoms-results from two Danish population-based surveys in 2012 and 2022
People often ignore bleeding, assuming it's minorRetrospectiveModerate qualityRelated question
75,751 people2026
Among people who reported rectal bleeding and did not contact a GP, 17% said they felt embarrassed, and many believed they knew the cause or expected it to resolve on its own
Who was studied
Danish adults surveyed about colorectal cancer symptoms, including rectal bleeding, in 2012 and 2022
Main outcome
Whether people with CRC symptoms (including rectal bleeding) contacted their GP, and their reasons for not doing so
Quality
Large nationwide surveys with tens of thousands of respondents give reliable behavioural data, but it relies on self-report and does not investigate the medical cause of the bleeding itself.
Limitations
The study looks at healthcare-seeking behaviour after symptoms, not at what actually causes bright red rectal bleeding; participants were not diagnosed or examined to determine the source of bleeding.
Taken word for word from the abstract
- n We included 47,423 individuals in 2012, and 28,328 in 2022.
- population Nationwide surveys on symptoms and GP contact in 2012 and 2022 with 100,000 randomly selected adults invited in each.
- primaryOutcome analyze the associations between sex, age and GP contact in 2012 and 2022, and 3. explore considerations about GP contact in 2022
- result Among those who reported rectal bleeding and no GP contact, 17% described embarrassment.
- result Among those with no GP contact, half reported either knowing the cause of their symptom or expecting it to resolve on its own.
Scand J Prim Health Care · PMID 41052213 · Read it on PubMed ↗
Liu et al. 2025
Current Status of Diagnosis and Treatment of Cap Polyposis: Insights From Chinese Studies and Comparative Analysis with Japanese Cases
Rare polyps can cause bleedingSystematic reviewLow qualityRelated question
57 peoplemedian follow-up of 14 months
Among patients with confirmed cap polyposis, bright red blood in stool (hematochezia) was the most common symptom, occurring in about 60% of cases, alongside diarrhea; polyps were mostly in the rectum and recurrence was common after treatment
Who was studied
Patients in China and Japan diagnosed with cap polyposis, a rare non-neoplastic colorectal condition
Main outcome
Clinical symptoms, diagnosis, and treatment outcomes of cap polyposis
Quality
This is a small pooled review of only 57 patients with a rare, already-diagnosed condition, not a study of people presenting with unexplained bright red bleeding on wiping.
Limitations
Small sample size, regional focus, retrospective data from multiple small studies, and the population already had a confirmed diagnosis of cap polyposis rather than undifferentiated rectal bleeding
Taken word for word from the abstract
- population studies from Mainland China, pathologically confirmed CP cases
- n Fourteen studies involving 57 patients were included.
- primaryOutcome This review aims to systematically analyze the clinical characteristics, management, and outcomes of CP in Chinese patients
- result The most common symptoms were hematochezia (59.6%) and diarrhea (28.1%).
- result During a median follow-up of 14 months, 10 patients experienced recurrence.
- followUp median follow-up of 14 months
Int J Gen Med · PMID 41031054 · Read it on PubMed ↗
Brim et al. 2025
Advanced-stage colorectal cancer in the context of coronavirus disease-19, highlighting socioeconomic disparities and outcomes: a case report
One case: bleeding was colon cancer.Case seriesVery low qualityRelated question
1 people2025
The bleeding was caused by an advanced (stage IV) colon cancer with a large tumor in the sigmoid colon and spread to the liver, found after a colonoscopy; diagnosis had been delayed by missed follow-up screening during the COVID-19 pandemic
Who was studied
69-year-old African American man with a week of bright red blood from the rectum (hematochezia)
Main outcome
underlying cause of the rectal bleeding
Quality
This is a single patient case report, so it cannot show how common this cause is or apply to people in general.
Limitations
Single case report with no comparison group; findings specific to one patient and cannot be generalised to typical causes of bright red rectal bleeding.
Taken word for word from the abstract
- population A 69-year-old African American male patient presented with a primary concern of hematochezia for 1 week.
- primaryOutcome On colonoscopy, the patient was found to have a 3-cm fungating, ulcerated, partially obstructing mass in the sigmoid colon, histologically confirmed as well-differentiated adenocarcinoma with mismatch repair proficiency.
- result The patient was diagnosed with stage IV colorectal adenocarcinoma with hepatic metastases.
- result Despite a history of benign polyps, removed 10 years earlier, the lack of follow-up colonoscopy led to a delayed diagnosis.
- n A 69-year-old African American male patient presented with a primary concern of hematochezia for 1 week.
J Med Case Rep · PMID 41024295 · Read it on PubMed ↗
Wu et al. 2025
Anal adenocarcinoma with perianal Paget's disease: A case report
Rare cancer mimicking hemorrhoids.Case seriesVery low qualityRelated question
1 people12-month
the bleeding and symptoms were actually caused by a rare anal cancer (adenocarcinoma with Paget's disease), not hemorrhoids as originally diagnosed
Who was studied
an older woman with years of perianal itching, moisture and bright red blood who was repeatedly told it was hemorrhoids
Main outcome
finding the true cause of long-standing perianal symptoms and bleeding
Quality
this is a single patient's case report, so it cannot tell you how common this cause is or apply to most people with similar bleeding.
Limitations
single case, no comparison group, cannot estimate how often bleeding attributed to hemorrhoids is actually something else
Taken word for word from the abstract
- population A retrospective analysis was conducted on a 72-year-old female patient with a 2-year history of perianal moisture, pruritus, and hematochezia, who was repeatedly misdiagnosed with mixed hemorrhoids.
- n a 72-year-old female patient
- primaryOutcome The diagnosis of anal canal adenocarcinoma with secondary PPD was confirmed through colonoscopy, perianal skin biopsy, and immunohistochemical staining (CK7, CK20, etc.).
- result No recurrence or metastasis was observed during the 12-month follow-up.
World J Gastrointest Surg · PMID 40949398 · Read it on PubMed ↗
Teller et al. 2026
Clinical, endoscopic and histological characteristics of Chlamydia trachomatis proctitis in males
Chlamydia infection can cause rectal bleeding and ulcersRetrospectiveLow qualityRelated question
28 people2026
Among 28 men with confirmed Chlamydia trachomatis proctitis, 79% reported rectal bleeding, with endoscopy often showing rectal erythema, ulcers, and inflammation that was sometimes mistaken for cancer or IBD
Who was studied
men diagnosed with rectal Chlamydia trachomatis infection confirmed by PCR, most of whom had sex with other men
Main outcome
clinical, endoscopic, and histological features of confirmed Chlamydia trachomatis proctitis, including rectal bleeding as a symptom
Quality
this is a small, single-centre retrospective case series of already-diagnosed infections with no comparison group, so it cannot tell us how often chlamydia explains bleeding in people with undiagnosed symptoms
Limitations
Retrospective single-institution series limited to patients already confirmed to have Chlamydia trachomatis infection, mostly men who have sex with men with high rates of HIV and other STIs, so findings may not generalise to the broader population noticing blood on wiping with an undetermined cause.
Taken word for word from the abstract
- n A total of 28 male patients were included
- population A total of 28 male patients were included (median age 37, IQR 31-48). Among them, 20 patients reported having sex with males.
- primaryOutcome This study aims to describe the main clinical symptoms, together with endoscopic and histopathological characteristics of C. trachomatis proctitis in the general population.
- result The main clinical symptoms were rectal bleeding (79%) and diarrhoea (43%).
- result In 16 cases (57.1%), neoplasia, IBD or fissure was suspected according to endoscopy.
Gastroenterol Hepatol · PMID 40930415 · Read it on PubMed ↗
Zhong et al. 2025
Rare primary anorectal malignant melanoma presenting with painless hematochezia: a case report
Rare melanoma cause of bleedingCase seriesVery low qualityRelated question
1 people3 months postoperatively
Counted as a related question: This case report describes a single patient with anorectal malignant melanoma, a rare cancer causing bright red bleeding, rather than explaining the common causes of bright red blood on wiping in typical adults (like hemorrhoids or anal fissures).
the bleeding turned out to be caused by a rare anorectal malignant melanoma, initially mistaken for rectal cancer
Who was studied
an adult presenting with bright red blood in stool of unknown cause
Main outcome
underlying cause of the bright red rectal bleeding
Quality
this is a single patient case report, so it cannot tell us how common this cause is or apply broadly
Limitations
only one patient; a rare and unusual cause that is very unlikely to explain most bright red bleeding on wiping
Taken word for word from the abstract
- population a 51-year-old woman presenting with persistent bright red blood in her stool
- primaryOutcome a high suspicion of rectal cancer was initially raised
- result subsequent histopathological evaluation of biopsy specimens revealed immunohistochemical positivity for MelanA, S100, and Ki-67 (~30%), suggesting a probable diagnosis of malignant melanoma
- n a 51-year-old woman
Front Oncol · PMID 40909963 · Read it on PubMed ↗
Al-Shehari et al. 2025
Malignant peripheral nerve sheath tumor of the sigmoid colon: A case report and comparison with published cases
Rare tumor found, not typical causeCase seriesVery low qualityRelated question
1 peopleshort-term
a rare cancerous nerve tumor in the lower colon was found to be causing the bleeding, and it was surgically removed
Who was studied
a 46-year-old woman with years of rectal bleeding and abdominal pain
Main outcome
cause of the rectal bleeding found on investigation
Quality
this is a single rare case report, so it cannot tell us what usually causes bright red blood on wiping.
Limitations
single case report of an extremely rare tumor, not a study of typical causes of bright red rectal bleeding on wiping
Taken word for word from the abstract
- population a 46-year-old female who presented with a four-year history of intermittent rectal bleeding and lower abdominal pain
- primaryOutcome A diagnostic workup, including imaging and colonoscopy, revealed a large ulcerated polypoid mass at the rectosigmoid junction
- result The definitive diagnosis of MPNST was confirmed through histopathology and a comprehensive immunohistochemical panel
- result The patient underwent successful complete surgical resection with clear margins, which resulted in favorable short-term outcomes
- n We report the case of a 46-year-old female
Int J Surg Case Rep · PMID 40840072 · Read it on PubMed ↗
Ashburn 2025
Hemorrhoidal Disease: A Review
Reviews hemorrhoid treatment, not undiagnosed bleedingNarrative reviewLow qualityRelated question
size not given2025
Describes hemorrhoids as a cause of bleeding, pain, and prolapse, and reviews treatments, but does not address undiagnosed bright red bleeding on wiping as a presenting symptom with unknown cause
Who was studied
People already diagnosed with hemorrhoidal disease, not people presenting with undiagnosed rectal bleeding on wiping
Main outcome
Causes, classification, and treatment of hemorrhoidal disease
Quality
This is a narrative review of a single already-diagnosed condition (hemorrhoids) and its treatments, not a study addressing why bleeding on wiping happens or its range of causes in people without a diagnosis yet.
Limitations
Narrative review (not systematic), focused on patients already diagnosed with hemorrhoidal disease rather than on undiagnosed rectal bleeding noticed on wiping; does not address other causes of bright red bleeding (e.g., fissures, polyps) or how to distinguish them.
Taken word for word from the abstract
- population Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US.
- primaryOutcome Hemorrhoidal disease may impair quality of life due to bleeding, pain, anal irritation, and tissue prolapse.
- result Internal hemorrhoids originate above the dentate line, the boundary between the upper and lower anal canal, and may cause rectal bleeding, discomfort, and tissue prolapse from the anal canal.
JAMA · PMID 40824576 · Read it on PubMed ↗
Parvathy et al. 2025
Polypoidal rectal endometriosis-a diagnostic dilemma
Rare cause: rectal endometriosisCase seriesVery low qualityRelated question
1 people2025
the cause was found to be polypoidal rectal endometriosis (endometrial tissue growing in the rectum), initially mistaken for cancer on imaging and biopsies
Who was studied
a 37-year-old woman with 2 years of non-cyclical rectal bleeding, weight loss, and passing polyp-like tissue from the rectum
Main outcome
what was causing the rectal bleeding and polyp-like tissue
Quality
this is a single patient case report, so it cannot show how common this cause is or apply to most people with bright red rectal bleeding.
Limitations
single case, rare condition, biopsies repeatedly failed to catch the true diagnosis until surgical resection, and the woman had unusual features (weight loss, passing polypoid tissue) not typical of simple bleeding on wiping
Taken word for word from the abstract
- population We report such a case of 37-year-old female with a 2-year history of non-cyclical rectal bleeding, weight loss, and spontaneous passage of polypoid tissue per rectum.
- primaryOutcome Imaging studies revealed findings suspicious for malignancy, while repeated endoscopic biopsies showed only inflammatory or hyperplastic colonic epithelium with reactive atypia.
- result Histopathological examination of the resected specimen rendered the diagnosis of polypoidal rectal endometriosis.
- n We report such a case of 37-year-old female
J Surg Case Rep · PMID 40808929 · Read it on PubMed ↗
Terashima et al. 2025
Cancers in an aging population with severe motor and intellectual disabilities: a single-center retrospective cohort study
Not about this symptomRetrospectiveLow qualityRelated question
186 peopleJanuary 2002 and December 2022
Colorectal and breast cancer rates were higher than in the general population; colorectal cancer was linked to frequent visible blood in stool and prior positive stool occult blood tests
Who was studied
Aging people with severe motor and intellectual disabilities living in a care ward
Main outcome
Characteristics and incidence of cancers, including colorectal cancer
Quality
Single-center retrospective study in a very specific institutionalized population, not people who simply notice blood on wiping, so it cannot speak to the cause of that symptom in general adults.
Limitations
Single center, retrospective, small numbers of cancer cases, and a population with severe disabilities that does not match adults noticing blood on wiping with undetermined cause
Taken word for word from the abstract
- population Clinical records of 186 individuals residing in the SMID ward between January 2002 and December 2022 were reviewed.
- primaryOutcome To investigate the characteristics of cancers in aging individuals with severe motor and intellectual disabilities (SMID).
- result Colorectal cancer incidence was significantly associated with frequent gross hematochezia and the number of preceding years with positive fecal occult blood test results, as well as marginally with the frequency of enemas.
- n Clinical records of 186 individuals residing in the SMID ward between January 2002 and December 2022 were reviewed.
Brain Dev · PMID 40784291 · Read it on PubMed ↗
Al-Bitar et al. 2025
Synchronous triple-negative breast cancer, rectal adenocarcinoma, and chemotherapy-induced hepatitis B virus reactivation: a case report and review of the literature
Bleeding was a sign of rectal cancerCase seriesVery low qualityRelated question
1 people3-year follow-up
the patient's rectal bleeding led to a diagnosis of rectal cancer
Who was studied
a 55-year-old woman with triple-negative breast cancer and hepatitis B
Quality
this is a single complex case report of a cancer patient, not a study of the general population who notice blood on wiping
Limitations
single case with multiple serious comorbidities (breast cancer, BRCA mutation, hepatitis B reactivation) unlike the general population asking about blood on wiping
Taken word for word from the abstract
- population a 55-year-old Arab woman diagnosed with a rapidly growing triple-negative breast cancer
- result the patient developed rectal bleeding, leading to the diagnosis of a mid-rectal invasive adenocarcinoma
- n a 55-year-old Arab woman
- followUp at a 3-year follow-up, remains healthy and disease-free
J Med Case Rep · PMID 40753237 · Read it on PubMed ↗
Merchan et al. 2025
Cavernous Hemangioma of the Anal Canal Mimicking a Neoplasm: A Rare Cause of Lower Gastrointestinal Bleeding Successfully Treated With Transanal Excision
Rare blood-vessel growth caused the bleeding.Case seriesVery low qualityRelated question
1 peoplethree-month follow-up
Counted as a related question: This study describes one specific rare cause (cavernous hemangioma) of rectal bleeding and its treatment, rather than explaining the common reasons why someone might see bright red blood when wiping—such as hemorrhoids, anal fissures, or minor irritation.
the bleeding was caused by a rare blood-vessel growth (cavernous hemangioma) in the anal canal, which was surgically removed with complete resolution of symptoms
Who was studied
a 75-year-old woman with a year of painless rectal bleeding
Main outcome
finding the cause of the bleeding and treating it
Quality
it is a single patient's case report, so it cannot show how common this cause is among people with this symptom
Limitations
only one patient, and the cause found (a rare vascular malformation) is an uncommon explanation for bright red rectal bleeding, so it may not apply to most people with this symptom
Taken word for word from the abstract
- population We report the case of a 75-year-old female patient with a one-year history of painless rectal bleeding
- n a 75-year-old female patient
- primaryOutcome Definitive treatment was achieved through transanal full-thickness excision, with complete resolution of symptoms and no recurrence at the three-month follow-up.
- result Histopathological examination after biopsy confirmed the diagnosis of cavernous hemangioma.
- result Definitive treatment was achieved through transanal full-thickness excision, with complete resolution of symptoms and no recurrence at the three-month follow-up.
Cureus · PMID 40525030 · Read it on PubMed ↗
Huang et al. 2025
A rare case of rectal malignant melanoma with long-term survival: case report and literature review
Rare melanoma cause of bleeding.Case seriesVery low qualityRelated question
1 people48 months
the bleeding was caused by a rare rectal malignant melanoma, found incidentally during surgery for hemorrhoids
Who was studied
a 56-year-old woman with a perianal mass and bright red blood after bowel movements
Main outcome
underlying cause of the rectal bleeding
Quality
this is a single case report of an extremely rare cancer, so it cannot show what usually causes bright red bleeding on wiping
Limitations
single patient, describes a very rare malignancy rather than the common causes of bleeding seen on wiping
Taken word for word from the abstract
- population A 56-year-old female presented to the hospital with a 10-day history of a perianal mass and hematochezia.
- primaryOutcome Postoperative histopathological analysis, supported by immunohistochemical staining, confirmed the diagnosis of malignant melanoma.
- result This case of rectal malignant melanoma, incidentally diagnosed during hemorrhoidectomy, was successfully treated with laparoscopic Miles' procedure and targeted immunotherapy, resulting in long-term disease-free survival
- n A 56-year-old female presented to the hospital
World J Surg Oncol · PMID 40483466 · Read it on PubMed ↗
Dubey et al. 2025
A Case of Retrorectal Melanoma Presenting With Bleeding Per Rectum
Rare case: hidden melanoma, not hemorrhoidsCase seriesVery low qualityRelated question
1 peopleapproximately three months
the bleeding turned out to be caused by a rare metastatic melanoma that had spread to the rectum, liver, and lungs, not the hemorrhoids she was first diagnosed with
Who was studied
a 56-year-old woman with rectal bleeding, initially thought to be from hemorrhoids
Main outcome
identifying the underlying cause of the rectal bleeding
Quality
this is a single patient's case report, so it cannot say how common this cause is or apply to people in general with this symptom
Limitations
describes only one patient with an advanced, rare cancer rather than the usual causes of bright red rectal bleeding seen on wiping; the bleeding was not described as the classic 'blood on the toilet paper' pattern
Taken word for word from the abstract
- population a 56-year-old female who presented to the ED with rectal bleeding
- primaryOutcome Biopsies of a liver lesion and a rectal mass confirmed the diagnosis of metastatic melanoma.
- result Imaging studies, including chest radiography and CT of the chest, abdomen, and pelvis, demonstrated multiple metastatic lesions in the lungs and liver, as well as a large retrorectal mass.
- result a prior history of hemorrhoids led to an initial discharge without further workup
- n a 56-year-old female who presented to the ED with rectal bleeding
- followUp passing away approximately three months after the initial presentation
Cureus · PMID 40452729 · Read it on PubMed ↗
Khoury et al. 2025
Lymphogranuloma venereum proctosigmoiditis misdiagnosed as inflammatory bowel disease: A case report
Rare STI mimicked IBD, caused bleedingCase seriesVery low qualityRelated question
1 people2025
Bleeding was due to a sexually transmitted infection (LGV) misdiagnosed first as hemorrhoids and then suspected as inflammatory bowel disease; it resolved with doxycycline after Chlamydia trachomatis was confirmed
Who was studied
38-year-old man with a month of rectal bleeding, mucus discharge and abdominal pain
Main outcome
underlying cause of rectal bleeding and discharge
Quality
This is a single patient case report, so it cannot show how common this cause is or apply broadly to people who notice blood on wiping.
Limitations
Single case report of one rare infectious cause; initial hemorrhoid treatment and endoscopy findings are described but this does not represent typical causes of bright red bleeding on wiping.
Taken word for word from the abstract
- population A 38-year-old male presenting with symptoms of rectal bleeding, mucoid discharge, and abdominal pain during the past month.
- primaryOutcome endoscopy revealed the presence of mucosal edema and ulcerations in the rectosigmoid area rendering IBD a plausible diagnosis theoretically, but practically refuted due to the negative biopsy results, and positive result of nucleic acid amplification testing of the rectal swab sample for Chlamydia trachomatis
- result Accordingly, medical therapy with doxycycline was instituted, which yielded a notable symptomatic relief
- n A 38-year-old male
World J Clin Cases · PMID 40385297 · Read it on PubMed ↗
Hamada et al. 2025
Follicular Lymphoma Manifesting as an Isolated Colorectal Polyp-Like Morphology
Rare lymphoma mimicking a polypCase seriesVery low qualityRelated question
1 people2025
Bleeding was due to a rare colon lymphoma that looked like a polyp, not a common cause like hemorrhoids
Who was studied
A 60-year-old woman with rectal bleeding
Main outcome
Cause of rectal bleeding found on colonoscopy
Quality
This is a single unusual case report, so it cannot tell us what usually causes bright red bleeding on wiping.
Limitations
Single case of a rare cancer; not representative of typical causes of bright red rectal bleeding.
Taken word for word from the abstract
- population A 60-year-old woman presented with hematochezia.
- primaryOutcome Colonoscopy incidentally identified an 8-mm polyp in the transverse colon, which was subsequently removed via cold snare polypectomy.
- result Histopathological examination confirmed Grade 1 FL, with immunohistochemical analysis revealing positivity for CD10, CD20, and Bcl-2.
- n A 60-year-old woman presented with hematochezia.
JGH Open · PMID 40314026 · Read it on PubMed ↗
Badshah et al. 2025
Ileocecal intussusception secondary to giant ileal lipoma in patient with chronic constipation: a case report
Rare case: bowel lipoma caused bleeding.Case seriesVery low qualityRelated question
1 people2025
Colonoscopy and CT found the small intestine telescoping into the cecum (intussusception) caused by a 3 cm lipoma in the terminal ileum; surgery removed the lipoma and resolved the intussusception.
Who was studied
a 53-year-old man with 2 years of chronic constipation, mild abdominal pain, and rectal bleeding
Main outcome
underlying cause of the patient's chronic constipation, abdominal pain, and rectal bleeding
Quality
This is a single rare case report, so it cannot tell us what usually causes bright red blood on wiping in general.
Limitations
Only one patient with a rare structural lesion (ileal lipoma causing intussusception) plus chronic constipation; not representative of typical causes of bright red blood noticed on wiping, and bleeding was not specifically characterized as surface/wiping blood.
Taken word for word from the abstract
- n A 53-year-old male presented with chronic constipation, mild abdominal pain, and rectal bleeding for 2 years.
- population A 53-year-old male presented with chronic constipation, mild abdominal pain, and rectal bleeding for 2 years.
- primaryOutcome A colonoscopy revealed protrusion of the small intestine through the ileocecal valve into the cecum with a 3 cm lipoma as the leading point.
- result The patient underwent laparotomy, the lipoma was excised, and the intussusception was resolved.
Ann Med Surg (Lond) · PMID 40212177 · Read it on PubMed ↗
Han et al. 2025
Exploring the diagnostic potential of plasma circ-CCDC66 in colorectal cancer
Blood marker detects colorectal cancer, not about bleeding causeCase-controlLow qualityRelated question
150 people2025
plasma circ-CCDC66 distinguished colorectal cancer and polyp patients from healthy people with high accuracy (AUC 0.920), better than standard tumor markers CEA and CA19-9
Who was studied
adults with colorectal cancer, colorectal polyps, or no disease (healthy controls)
Main outcome
accuracy of a blood marker (circ-CCDC66) for detecting colorectal cancer and polyps
Quality
it is a small lab-based biomarker study comparing blood samples from three groups, not a study of people presenting with rectal bleeding of undetermined cause, so it says little about why bleeding happens on wiping.
Limitations
This study examines a blood biomarker for diagnosing colorectal cancer in already-categorized patient groups; it does not study people who notice bright red blood on wiping or investigate causes of that symptom.
Taken word for word from the abstract
- population qPCR analysis of plasma samples from 50 CRC patients, 50 with colorectal polyps, and 50 healthy individuals
- n 50 CRC patients, 50 with colorectal polyps, and 50 healthy individuals
- primaryOutcome circ-CCDC66 emerged as a promising biomarker for CRC detection capable of identifying polyps among healthy individuals
- result plasma circ-CCDC66 levels exhibited superior diagnostic accuracy, with an AUC of 0.920, compared to traditional markers, such as serum CEA and CA19-9
Sci Rep · PMID 40181128 · Read it on PubMed ↗
Tian et al. 2025
Rare large sigmoid hamartomatous polyp in an elderly patient with atypical Peutz-Jeghers syndrome: A case report
Rare polyp syndrome caused the bleedingCase seriesVery low qualityRelated question
1 peoplelater follow-up (duration not specified)
The bleeding was traced to a rare large hamartomatous (Peutz-Jeghers) polyp in the sigmoid colon, which was surgically removed, after which symptoms improved
Who was studied
62-year-old man with abdominal pain and occasional blood in stool, later diagnosed with Peutz-Jeghers syndrome
Main outcome
cause of the rectal bleeding (hematochezia) found on investigation
Quality
This is a single, highly unusual case report of a rare genetic syndrome, so it cannot show what usually causes bright red bleeding on wiping in typical adults.
Limitations
Single patient with a rare genetic syndrome (Peutz-Jeghers), not representative of the general population who notice blood on wiping with an undetermined cause; no control group or broader population studied.
Taken word for word from the abstract
- population A 62-year-old male presented with intermittent left lower abdominal pain after drinking or consuming cold beverages that was accompanied by occasional hematochezia.
- primaryOutcome Abdominal contrast-enhanced computed tomography indicated an isolated sigmoid colon grape-like lesion.
- result the pathological diagnosis was PJ hamartomatous polyp
- result After laparoscopic sigmoid colon resection, the patient's symptoms improved, and no discomfort symptoms were reported in the later follow-up.
- n A 62-year-old male presented
World J Gastrointest Surg · PMID 40162387 · Read it on PubMed ↗
Torres-Larrubia et al. 2025
Isolated colonic amyloidosis: a rare condition mimicking malignancy
Rare cause: colon amyloidosis mimicking cancerCase seriesVery low qualityRelated question
1 people2025
biopsy showed amyloid deposits (colonic amyloidosis) rather than cancer
Who was studied
a 54-year-old man with rectal bleeding found to have a rare colon condition
Main outcome
finding the cause of a colon lesion that looked like cancer
Quality
this is a single rare case report, so it cannot tell us what usually causes bright red bleeding on wiping
Limitations
single patient with a very rare diagnosis found incidentally during investigation of a suspicious lesion, not a study of typical causes of blood seen on wiping
Taken word for word from the abstract
- population a 54-year-old male with localized colonic amyloidosis presenting as rectal bleeding
- primaryOutcome Initial colonoscopy revealed a neoplastic-appearing lesion in the descending colon, but histopathology identified amyloid deposits
- result histopathology identified amyloid deposits, confirmed by Congo Red staining
- n We report the case of a 54-year-old male
Rev Esp Enferm Dig · PMID 40145894 · Read it on PubMed ↗
Groshilin et al. 2025
[Treatment of acute hemorrhoids according to the results of a multicenter observational study]
Studied hemorrhoid treatment, not cause of bleedingProspective cohortLow qualityRelated question
220 people30 days
Symptoms including bleeding, pain and itching decreased over 7 to 30 days of treatment, and quality of life scores improved, with no reported adverse effects
Who was studied
Adults aged 18 to 64 already diagnosed with grade I-II acute hemorrhoids (including bleeding ones)
What they received
Phlebodia 600 (diosmin) oral venotonic drug for at least 36 days
Compared with
No comparator group; symptoms compared to patients' own baseline before treatment
Main outcome
Resolution of hemorrhoid symptoms (pain, bleeding, itching, discomfort) and quality of life
Quality
It is an uncontrolled observational study of people already diagnosed with hemorrhoids, so it cannot show why bleeding happens or rule out other causes.
Limitations
No control group, so improvement could reflect natural resolution of acute hemorrhoids rather than the drug; population was pre-diagnosed with hemorrhoids rather than people with undetermined rectal bleeding.
Taken word for word from the abstract
- population Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids (thrombosis of external or internal hemorrhoidal nodes, including those with bleeding) established through standardized clinical examination were included.
- intervention Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms
- comparator The total sample size analyzed was 220 patients, and the medication was administered for at least 36 days.
- primaryOutcome The study aimed to assess the effectiveness of using Phlebodia 600 and evaluate the dynamics of patients' quality of life with acute hemorrhoids of grades I-II in outpatient practice
- result early resolution and reduction of complaints such as pain, discomfort, itching, and blood streaks during defecation were observed by the control visit after seven days of therapy, compared to baseline
- n The total sample size analyzed was 220 patients
Khirurgiia (Mosk) · PMID 40103253 · Read it on PubMed ↗
Sapkota Upadhya et al. 2024
Efficacy and Safety of Colonoscopic Band Ligation for Lower Gastrointestinal Bleeding due to Hemorrhoid
Band ligation relieved existing hemorrhoid bleedingCase seriesLow qualityRelated question
28 people3 months
bleeding resolved in 96.4% and prolapse in 92% of patients by 3 months; irritation, discharge and pain resolved in all patients; complications occurred in 53.5% of cases; 78.6% rated treatment as excellent
Who was studied
adults with grade II hemorrhoids causing lower gastrointestinal bleeding, already diagnosed and referred for treatment
What they received
colonoscopic rubber band ligation of hemorrhoids
Main outcome
resolution of bleeding, prolapse, irritation, discharge and pain after treatment, plus patient satisfaction
Quality
small single-center study of only 28 selected patients with no comparison group and short follow-up, so it cannot reliably establish cause-effect or generalize.
Limitations
Small sample (28 of 108 eligible patients), no control group, only 3-month follow-up, single tertiary center, and the authors themselves call for multicenter research with longer follow-up.
Taken word for word from the abstract
- population We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding
- intervention Colonoscopic Rubber band ligation for lower Lower gastrointestinal bleeding due to hemorrhoids
- primaryOutcome Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively.
- result Symptoms of irritation, discharge, pain resolved in all patients at 3 months and that of bleeding and prolapse in 96.4% and 92% respectively. 75% were able to resume work the day after the procedure. Post-procedure complications were reported in 53.5% of cases. 78.6% of patients rated Colonoscopic Rubber band ligation treatment as "excellent help".
- n We included 28 among 108 patients presenting to the surgical outpatient department with Lower gastrointestinal bleeding.
J Nepal Health Res Counc · PMID 39923169 · Read it on PubMed ↗
Johannesen et al. 2025
A Novel Case of Biallelic MLH3 Variants in a Patient With Rectal Cancer and Polyps
Rare genetic cancer cause in one caseCase seriesVery low qualityRelated question
1 people2025
Genetic testing found two rare MLH3 gene mutations linked to a rectal cancer and polyps that had caused her bleeding
Who was studied
A 47-year-old woman who had rectal bleeding
Main outcome
What caused her rectal bleeding and rectal tumor
Quality
This is a single, highly unusual case report of a rare genetic cancer syndrome, so it says nothing about the common causes of bright red blood on wiping.
Limitations
Single case report of a rare inherited cancer syndrome; not representative of the general population who notice blood on wiping.
Taken word for word from the abstract
- population The patient, a 47-year-old woman, presented with rectal bleeding
- primaryOutcome presented with rectal bleeding, leading to the discovery of a malignant rectal tumor and adenomas during colonoscopy
- result genetic testing identified two likely pathogenic frameshift variants in MLH3 located in trans
- n The patient, a 47-year-old woman, presented with rectal bleeding
Clin Genet · PMID 39789695 · Read it on PubMed ↗
Baş et al. 2025
Emborrhoid technique in hemorrhoidal disease: Retrospective analysis of data from a single center
Embolization reduced bleeding in severe hemorrhoidsRetrospectiveLow qualityRelated question
18 people6 months
Bleeding severity scores fell from a mean of 6.6 before treatment to about 3.4-3.8 over follow-up, with clinical success in 95% of patients at 1 month and 85% at 3 and 6 months, and no procedure-related complications
Who was studied
Adults already diagnosed with severe (Goligher grade 4) hemorrhoids causing rectal bleeding who were not candidates for surgery
What they received
Coil embolization of the superior rectal artery (the "emborrhoid" technique)
Main outcome
Severity of rectal bleeding and clinical success after the procedure, measured with the Paris bleeding severity score
Quality
It is a small, single-center, retrospective study with only 18 patients, no comparison group, and short follow-up, so its findings carry little weight.
Limitations
Retrospective design, single center, very small sample (18 patients), no control group, and follow-up limited to 6 months.
Taken word for word from the abstract
- population rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated
- intervention coil embolization of the superior rectal artery
- primaryOutcome evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding
- result Clinical success was 95% at the first month and 85% at the third and sixth months.
- result The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month.
- n 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study
Ulus Travma Acil Cerrahi Derg · PMID 39775512 · Read it on PubMed ↗
Shalata et al. 2024
Colorectal Cancer in Elderly Patients: Insights into Presentations, Prognosis, and Patient Outcomes
Bleeding sometimes signals bowel cancerRetrospectiveLow qualityRelated question
724 people2024
Among elderly patients already diagnosed with colorectal cancer, rectal bleeding (hematochezia) was the presenting symptom in 17.82% of cases, behind abdominal pain (31.49%) and anemia (18.08%)
Who was studied
elderly patients aged 70 and over diagnosed with colorectal cancer
Main outcome
symptoms that led to colorectal cancer diagnosis and prognostic factors
Quality
This is a single-center retrospective chart review of patients already known to have colorectal cancer, so it cannot tell us how often bright red bleeding on wiping in the general population is due to cancer versus other causes.
Limitations
Retrospective, single-center, includes only patients who already had confirmed CRC and underwent surgery/systemic therapy, so it cannot address the broader population with undiagnosed bleeding on wiping.
Taken word for word from the abstract
- population This retrospective, observational study analyzed 724 CRC elderly patients aged 70 and over (median age 80, 53.17% male), treated at a single center.
- n 724 CRC elderly patients aged 70 and over
- primaryOutcome The main symptoms prompting patients to start an investigation of CRC were abdominal pain (31.49%), anemia (18.08%), rectal bleeding (hematochezia) (17.82%), change in bowel habits (9.94%), and weight loss (7.60%).
- result rectal bleeding (hematochezia) (17.82%)
Medicina (Kaunas) · PMID 39768833 · Read it on PubMed ↗
Ansari et al. 2024
Histopathological Complexities and Diagnostic Challenges in Familial Adenomatous Polyposis: A Case Report
Case report on FAP polyp diagnosis, not bleeding causeCase seriesVery low qualityRelated question
1 people2024
Histopathological evaluation showed a mix of chief and parietal cells in the polyps, leading to a diagnosis of mixed hyperplastic/fundic gland polyps with focal low-grade dysplasia rather than oxyntic adenomas
Who was studied
19-year-old man with family history of familial adenomatous polyposis who had abdominal pain, altered bowel habits and rectal bleeding
Main outcome
correctly diagnosing the type of colon polyp found on colonoscopy
Quality
This is a single case report of one patient with a known genetic condition, so it cannot tell us why typical rectal bleeding on wiping happens in the general population.
Limitations
Single patient case report in someone with a known inherited polyposis syndrome and multiple GI symptoms, not a study of isolated bright red bleeding on wiping with undetermined cause.
Taken word for word from the abstract
- population a 19-year-old male patient with a known family history of FAP who presented with recurrent lower abdominal pain, altered bowel habits, and rectal bleeding
- primaryOutcome This case highlights the diagnostic complexities in distinguishing between oxyntic adenomas and mixed hyperplastic/fundic gland polyps in FAP patients
- result further detailed evaluation, which identified a significant population of both chief and parietal cells within the glandular pits, supported the diagnosis of mixed hyperplastic/fundic gland polyps with focal low-grade dysplasia
- n a 19-year-old male patient
Cureus · PMID 39640151 · Read it on PubMed ↗
Lei et al. 2024
Does hemorrhoidal artery embolization really benefit patients with hemorrhoids?
Discusses hemorrhoid treatment, not bleeding cause.Narrative reviewVery low qualityRelated question
size not given2024
The letter argues that patient selection, choice of embolization materials and embolization method affect how well the procedure works and whether it causes complications, and discusses how to pick candidates and methods to improve safety and effectiveness.
Who was studied
people being considered as candidates for hemorrhoidal artery embolization
What they received
hemorrhoidal artery embolization
Main outcome
safety and effectiveness of the embolization procedure
Quality
This is an editorial/letter commentary on another article, not a study with its own patients, data or outcomes, so it carries very little evidentiary weight.
Limitations
It is a commentary, not original research; it does not study people with unexplained bright red bleeding on wiping, but rather discusses treatment selection in people already diagnosed with hemorrhoidal disease being considered for embolization.
Taken word for word from the abstract
- population the most appropriate candidate patients, embolization materials, embolization methods, and clinical evaluation methods are discussed
- intervention Hemorrhoidal artery embolization is a promising approach to severe hemorrhoidal bleeding treatment
- primaryOutcome to improve the safety and effectiveness of the procedure
- result inappropriate patient selection and the use of different embolization procedures may affect the clinical efficacy and cause serious complications
- result the most appropriate candidate patients, embolization materials, embolization methods, and clinical evaluation methods are discussed
World J Gastroenterol · PMID 39563747 · Read it on PubMed ↗
Huang et al. 2024
Endoscopic features of rectal mucosal prolapse syndrome (RMPS): Differentiation from malignant rectal tumor
Helps tell prolapse bleeding apart from rectal cancerRetrospectiveLow qualityRelated question
826 people2024
Patients with rectal mucosal prolapse syndrome were younger, had smaller lesions, and had symptoms for longer than patients with cancerous rectal tumors; five visual patterns of the prolapse lesions were identified
Who was studied
patients who had endoscopy for rectal lesions, masses or tumors
Main outcome
distinguishing rectal mucosal prolapse syndrome (a cause of rectal bleeding) from malignant rectal tumor on endoscopy
Quality
It is a retrospective review of a specialist referral population already undergoing endoscopy for a rectal lesion, not a study of people who simply notice blood on wiping with an undetermined cause.
Limitations
Retrospective data collection; population was patients already found to have a rectal lesion/mass on endoscopy, not a general population with rectal bleeding of undetermined cause.
Taken word for word from the abstract
- population Data from patients endoscopically diagnosed with rectal lesions, masses, or tumors, were retrospectively collected.
- n 826 patients were enrolled
- primaryOutcome This study aimed to investigate factors to distinguish RMPS and MRT and to explore endoscopic features of RMPS.
- result patients with RMPS were significantly younger (33.5 vs. 62, P < 0.001) and lesions were significantly smaller (2 cm vs. 3 cm, P = 0.007). Moreover, the clinical course of patients with RMPS was significantly longer than for those with MRT (12 months vs. 3 months, P < 0.001).
- result we classified lesions of RMPS into five phenotypes
Endosc Int Open · PMID 39559414 · Read it on PubMed ↗
Zhang et al. 2024
Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps
Bleeding linked to higher-risk polyps in older patientsRetrospectiveLow qualityRelated question
196 people2024
Rectal bleeding or occult blood was one of several factors independently associated with high-grade intraepithelial neoplasia, along with polyp location, size, type, family history, tumor markers, nutrition and frailty
Who was studied
older adults with colorectal polyps already diagnosed and classified by biopsy
Main outcome
risk factors associated with high-grade versus low-grade abnormal cell changes in colorectal polyps
Quality
This is a retrospective comparison of two small patient groups from one hospital, so it can show associations but cannot show that bleeding on wiping, by itself, is caused by or means polyps of a particular grade.
Limitations
Single-center retrospective design, small numbers, population restricted to older patients already diagnosed with colorectal polyps rather than people presenting with bleeding of undetermined cause, so the finding is not generalizable to otherwise-healthy people who just notice blood on wiping.
Taken word for word from the abstract
- population We selected 84 older patients diagnosed with HGIN as the HGIN group (n = 95 colonic polyps) and 112 older patients diagnosed with LGIN as the LGIN group (n = 132 colonic polyps) from Shandong Provincial Hospital Affiliated to Shandong First Medical University.
- n We selected 84 older patients diagnosed with HGIN as the HGIN group (n = 95 colonic polyps) and 112 older patients diagnosed with LGIN as the LGIN group (n = 132 colonic polyps)
- primaryOutcome To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.
- result patients who experienced rectal bleeding or occult blood, patients with elevated carcinoembryonic antigen (CEA) and cancer antigen 199 (CA199), and lower nutritional levels and higher frailty levels
- result family history of colorectal cancer, rectal bleeding or occult blood, elevated serum CEA and CA199 levels, lower nutritional levels and higher frailty levels also are independent risk factors for HGIN
World J Gastrointest Oncol · PMID 39473943 · Read it on PubMed ↗
Abu-Freha et al. 2024
Sex Differences in Colonoscopy Indications and Findings: Results from a Large Multicenter Database
Not directly answered; unrelated comparisonRetrospectiveModerate qualityRelated question
287,930 people2024
rectal bleeding was a more common indication for colonoscopy in men than women, and men had higher rates of polyps and colorectal cancer found on colonoscopy
Who was studied
men and women undergoing colonoscopy at multiple centers
Main outcome
differences in colonoscopy indications and findings between sexes
Quality
very large multicenter database but retrospective and cross-sectional so it cannot explain the underlying causes of rectal bleeding, only how often it was an indication and what was found overall
Limitations
Retrospective, cross-sectional design; looks at colonoscopy indications and findings broadly rather than specifically investigating the causes of bright red blood on wiping; findings are for all colonoscopy patients, not specifically people with isolated bright red bleeding on wiping.
Taken word for word from the abstract
- population A total of 151,411 (52.6%) women and 136,519 (47.4%) men were included, aged 56.54 ± 12.9 years and 56.59 ± 12.7.
- primaryOutcome We aimed to investigate the differences in colonoscopy indications and its findings between males and females.
- result positive FOBT, rectal bleeding and post-polypectomy surveillance and screening were more common indications among males (9.5% vs 7.8%, 10.7% vs 7.8%, and 10.8% vs 7.1%, respectively). On colonoscopy, males were found to have significantly higher colorectal cancer and polyps (0.5% vs 0.4% and 35.1% vs 24.6%).
- n A total of 151,411 (52.6%) women and 136,519 (47.4%) men were included
J Womens Health (Larchmt) · PMID 39445639 · Read it on PubMed ↗
Fiordaliso et al. 2024
Colonic lipoma, a rare cause of intestinal intussusception: A narrative review and how to diagnose it
Rare tumor can cause bleeding.Narrative reviewLow qualityRelated question
size not given2024
Colonic lipomas can cause abdominal pain, changes in bowel habits, rectal bleeding, and intussusception; diagnosis relies on imaging and sometimes surgery to rule out cancer
Who was studied
Patients with colonic lipomas (benign fatty tumors of the colon), a rare condition
Main outcome
Clinical features and diagnosis of colonic lipomas
Quality
This is a narrative review of a rare tumor condition, not a study of people presenting with rectal bleeding of undetermined cause, so it cannot speak to how common this cause is or how it compares to other causes.
Limitations
Narrative review (not systematic or meta-analysis), focused on a specific rare tumor diagnosis rather than on the general symptom of bright red bleeding on wiping; population already has a specific diagnosis rather than undetermined cause.
Taken word for word from the abstract
- population Colonic lipomas (CLs) are benign tumors of the adipose tissue of the gastrointestinal tract that are often asymptomatic.
- primaryOutcome A search of medical literature in English using PubMed and Google Scholar was conducted for articles related to CL.
- result Symptoms included abdominal pain (79.2%), alterations in bowel habits (45.8%), rectal bleeding (22.9%), colocolic intussusception (50%), weight loss (6.2%), vomiting (14.6%), and nausea (12.5%).
Medicine (Baltimore) · PMID 39331924 · Read it on PubMed ↗
Liao et al. 2024
Differences in characteristics and outcomes between early-onset colorectal cancer and late-onset colorectal cancers
More bleeding reported in young-onset cancerRetrospectiveModerate qualityRelated question
size not given2024
Rectal bleeding, along with changes in bowel habits and abdominal pain, was reported more often in the early-onset group than the late-onset group
Who was studied
People already diagnosed with colorectal cancer, comparing those diagnosed before age 50 with those diagnosed after age 50
Main outcome
Differences in symptoms, cancer features, and survival between early-onset and late-onset colorectal cancer
Quality
It is a large national registry plus hospital cohort, but it only studies people who already have a confirmed cancer diagnosis, and it relies on retrospective symptom recording.
Limitations
The study looks only at people already diagnosed with colorectal cancer rather than people with undifferentiated bright red bleeding on wiping, so it cannot explain what causes that symptom in the general population; symptom data are retrospective.
Taken word for word from the abstract
- population Using data from Taiwan's national cancer registry and a retrospective cohort from Chang Gung Memorial Hospital, this study analyzed CRC cases diagnosed between 2008 and 2019.
- primaryOutcome The analysis compared the EOCRC and late-onset CRC (LOCRC) groups in terms of clinicopathological characteristics, pre-diagnostic symptoms, and survival outcomes.
- result Patients with EOCRC reported rectal bleeding, changes in bowel habits, and abdominal pain more frequently than those in the LOCRC group.
Eur J Surg Oncol · PMID 39288563 · Read it on PubMed ↗
Kindie et al. 2024
Familial adenomatous polyposis: a case report
Rare polyposis cancer caused bleedingCase seriesVery low qualityRelated question
1 people2024
Rectal bleeding was caused by familial adenomatous polyposis with colorectal adenocarcinoma (multiple colon polyps that had become cancerous)
Who was studied
a 22-year-old woman with rectal bleeding
Main outcome
cause of rectal bleeding found on workup
Quality
A single case report cannot show how common this cause is among people who notice blood when wiping.
Limitations
Single patient case report; cannot establish how often this diagnosis explains rectal bleeding in the general population.
Taken word for word from the abstract
- population A 22-year-old Ethiopian female patient presented to Addis Ababa University College of Health science, Addis Ababa, Ethiopia with rectal bleeding.
- result Colonoscopy was done and she was diagnosed to have familial adenomatous polyposis with severe dysplasia. In the meantime, colonoscopy guided biopsy was taken and the diagnosis of adenocarcinoma with familial adenomatous polyposis was rendered.
- primaryOutcome In the clinical evaluation of a patient with rectal bleeding, familial adenomatous polyposis must be considered as a differential diagnosis
- n A 22-year-old Ethiopian female patient
J Med Case Rep · PMID 39244621 · Read it on PubMed ↗
Li et al. 2024
Colorectal Cancer Complicated with Chronic Schistosoma Japonicum Infected: A Case Report
Rare case: cancer plus parasite infectionCase seriesVery low qualityRelated question
1 people2024
Colonoscopy and biopsy found both colorectal cancer and chronic Schistosoma japonicum infection in the bowel wall as the underlying causes of bleeding
Who was studied
A 67-year-old man from a schistosomiasis-endemic region with months of intermittent rectal bleeding
Main outcome
Cause of the rectal bleeding found on investigation
Quality
A single patient case report cannot show what usually causes bright red bleeding on wiping in the general population.
Limitations
Single case from a schistosomiasis-endemic area with confirmed malignancy; not representative of typical patients noticing blood on wiping with no diagnosis yet.
Taken word for word from the abstract
- population A 67-year-old male from an endemic region presented with a six-month history of intermittent hematochezia.
- n A 67-year-old male from an endemic region presented with a six-month history of intermittent hematochezia.
- primaryOutcome Initial colonoscopy revealed multiple mucosal elevations in the sigmoid colon and rectum.
- result revealing adenocarcinoma of the rectal mucosa and tubular adenoma in the sigmoid colon, both with extensive deposition of Schistosoma japonicum eggs
Acta Parasitol · PMID 39225736 · Read it on PubMed ↗
Daðadóttir et al. 2024
Comparison of gastrointestinal bleeding in patients with and without liver cirrhosis
Not about this question.Case-controlLow qualityRelated question
493 people45 days
Hemorrhoids were a more common cause of bleeding in cirrhosis patients (40%) than in non-cirrhotics (6%); ulcers were less common in cirrhotics
Who was studied
Adults hospitalized with gastrointestinal bleeding, some with liver cirrhosis and some without
Main outcome
Causes and outcomes of gastrointestinal bleeding
Quality
This is a retrospective, hospital-based study of patients already hospitalized for bleeding, mostly comparing cirrhosis status, not people simply noticing blood on wiping.
Limitations
Retrospective design; population was hospitalized patients with serious/overt bleeding, not outpatients noticing blood on toilet paper; focused on comparing cirrhotic vs non-cirrhotic bleeding causes rather than explaining bright red rectal bleeding in general.
Taken word for word from the abstract
- population A retrospective study on cirrhotics hospitalized for GIB 2010-2021, matched with control group of non-cirrhotics (1:4) for upper vs. lower GIB.
- n Overall, 396 patients had cirrhosis
- n matched with 391 non-cirrhotics
- primaryOutcome The clinical characteristics, management and outcomes in patients with and without liver cirrhosis was compared to determine the overall features of GIB in patients with liver cirrhosis compared with non-cirrhotics.
- result hemorrhoids 40% vs. 6% (p = 0.002)
- result less commonly gastric ulcer 13% vs. 31% (p < 0.001), duodenal ulcer 9% vs. 29% (p < 0.001)
Scand J Gastroenterol · PMID 39105571 · Read it on PubMed ↗
Oguntoye et al. 2024
Histopathological Outcome of Colonoscopic Biopsies in a Tertiary Hospital in Southwestern Nigeria: A 7-Year Retrospective Study
Biopsies often found colon cancerRetrospectiveLow qualityRelated question
81 people2024
Colorectal cancer was the most common biopsy finding (32.1%), followed by chronic colitis, polyps and adenomas; 27.2% had normal findings
Who was studied
Adults aged 30-86 having colonoscopy at a Nigerian hospital for various bowel symptoms, including some with visible blood in stool
Main outcome
Histopathological (biopsy) diagnosis found at colonoscopy
Quality
Small retrospective single-centre chart review with no breakdown of findings specifically for patients who wiped and saw bright red blood, so it cannot show how often that exact symptom has a serious versus benign cause.
Limitations
Retrospective design, single hospital in Nigeria, mixed group of colonoscopy indications (hematochezia was only one of several), no separate analysis for bright red blood on wiping with otherwise undetermined cause.
Taken word for word from the abstract
- n The data of a total number of 81 patients were analyzed
- population This was a retrospective study conducted in a healthcare facility in southwestern Nigeria
- population The age range of the patients was 30-86 years
- primaryOutcome to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy
- result Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%])
- result Twenty-two (27.2%) patients had normal histologic findings
- population The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%])
Ann Afr Med · PMID 39028171 · Read it on PubMed ↗
Severova et al. 2024
Association Between Membranoproliferative Glomerulonephritis and Colorectal Cancer - A Case Report
Bleeding was caused by colon cancerCase seriesVery low qualityRelated question
1 peoplewithin a year after the cancer treatment
colonoscopy showed the bleeding was due to adenocarcinoma of the descending colon, not the kidney disease
Who was studied
a 48-year-old man with glomerulonephritis and nephrotic syndrome who developed worsening anemia and rectal bleeding
Main outcome
cause of the rectal bleeding
Quality
this is a single patient case report, so it cannot show what usually causes bright red bleeding on wiping in the general population
Limitations
single case report in a patient with serious underlying kidney disease and cancer, not representative of typical people noticing blood on wiping
Taken word for word from the abstract
- population A 48-year-old man presented with anemia, loss of weight, hypertension, and nephrotic syndrome.
- primaryOutcome due to the worsening anemia and rectal bleeding, a colonoscopy was performed
- result a colonoscopy was performed, which established a diagnosis of adenocarcinoma of the descending colon
- n A 48-year-old man presented with anemia, loss of weight, hypertension, and nephrotic syndrome.
Pril (Makedon Akad Nauk Umet Odd Med Nauki) · PMID 39008638 · Read it on PubMed ↗
Fickenscher et al. 2024
Diagnostic and therapy of an early-stage primary leiomyosarcoma of the sigmoid colon: A case report
Rare tumor caused the bleeding.Case seriesVery low qualityRelated question
1 people2024
the bleeding was caused by a rare, high-grade leiomyosarcoma tumor in the sigmoid colon, found after colonoscopy and surgical removal
Who was studied
a 53-year-old male patient who had intermittent rectal bleeding
Main outcome
cause of the rectal bleeding found on colonoscopy and surgery
Quality
This is a single patient case report, so it cannot show how common this cause is or apply to people in general.
Limitations
Only one patient is described, and the tumor found is an extremely rare cause of bleeding, not representative of most people who notice blood on wiping.
Taken word for word from the abstract
- population a 53-year-old male patient who underwent a colonoscopy due to intermittent rectal bleeding
- n We present the case of a 53-year-old male patient
- primaryOutcome histological examination surprisingly revealed a localized high-grade leiomyosarcoma
- result Colonoscopy revealed an intraluminal polypoid growing tumor in the sigmoid colon.
- result histological examination surprisingly revealed a localized high-grade leiomyosarcoma
Clin Case Rep · PMID 39005578 · Read it on PubMed ↗
Chen et al. 2024
Endoscopic injection of lauromacrogol foam sclerotherapy for rectal cavernous hemangioma: A case report
Rare blood-vessel tumor caused bleeding.Case seriesVery low qualityRelated question
1 people2 months
a rare vascular growth (rectal cavernous hemangioma) was identified as the cause of recurrent bright red bleeding in this one patient
Who was studied
a person with recurrent bright red rectal bleeding later found to have a rare vascular tumor
Main outcome
cause of the bleeding and response to treatment of a rare rectal vascular tumor
Quality
This is a single patient case report, so it cannot show how common this cause is or apply to people in general who notice blood on wiping.
Limitations
Single case report of one rare diagnosed vascular lesion, not a study of the general population who notice blood on wiping with an undetermined cause.
Taken word for word from the abstract
- n a 60-year-old male who was admitted to our hospital with a history of recurrent hematochezia
- population a 60-year-old male who was admitted to our hospital with a history of recurrent hematochezia for >1 year and worsening symptoms for 1 week
- primaryOutcome the final diagnosis was rectal cavernous hemangioma
- result Following colonoscopy, nuclear magnetic resonance imaging, computed tomography, and other examinations, the final diagnosis was rectal cavernous hemangioma.
Medicine (Baltimore) · PMID 38996140 · Read it on PubMed ↗
Domingues et al. 2024
Cap Polyposis-A Rare Cause of Rectal Bleeding in a Young Woman
Rare polyps caused her bleeding.Case seriesVery low qualityRelated question
1 people2024
Diagnosed with cap polyposis, a rare benign condition with inflammatory polyps in the rectum, found on endoscopy and confirmed by biopsy
Who was studied
A 35-year-old woman with rectal bleeding
Main outcome
Cause of rectal bleeding
Quality
This is a single case report of one person, so it cannot tell us how common this cause is or apply to the general question of blood on wiping.
Limitations
Single case report; cap polyposis is described as very rare; findings came from endoscopic and histologic workup in a patient already referred to a specialist, not from people presenting simply with blood noticed on wiping.
Taken word for word from the abstract
- population A 35-year-old woman was referred to our Gastroenterology department due to rectal bleeding.
- primaryOutcome Endoscopic examination revealed multiple polypoid lesions in the middle/lower rectum.
- result Histology was compatible with cap polyposis.
- n A 35-year-old woman was referred to our Gastroenterology department due to rectal bleeding.
ACG Case Rep J · PMID 38988719 · Read it on PubMed ↗
Ramanathan et al. 2024
The Importance of Digital Rectal Examination in Identifying Early-Onset Rectal Malignancies
Bleeding was cancer, not hemorrhoids.Case seriesVery low qualityRelated question
1 people2024
Counted as a related question: This study presents a case of rectal bleeding that turned out to be caused by cancer, but it focuses on the diagnostic importance of rectal exams rather than explaining why bright red bleeding occurs or what causes it in the general population of adults who experience this symptom.
the bleeding, originally blamed on internal hemorrhoids, turned out to be caused by a rectal adenocarcinoma found on colonoscopy
Who was studied
a 38-year-old man with rectal bleeding that doctors initially thought was from hemorrhoids
Main outcome
finding the true cause of the rectal bleeding
Quality
this is a single patient's case, so it cannot tell you how common this cause is or what usually happens.
Limitations
only one patient is described, so the finding cannot be generalized to most people with rectal bleeding.
Taken word for word from the abstract
- population a case of a 38-year-old male from West Virginia who was referred to general surgery for complaints of rectal bleeding attributed to internal hemorrhoids
- primaryOutcome the importance of performing rectal exams to identify rectal cancers early to expedite treatment
- result After undergoing a colonoscopy, the patient was found to have a rectal mass consistent with adenocarcinoma.
- n a case of a 38-year-old male
Cureus · PMID 38827000 · Read it on PubMed ↗
Elbadry et al. 2024
Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study
Hemorrhoids a common cause of rectal bleedingRetrospectiveLow qualityRelated question
5,910 people2024
Among patients referred for colonoscopy, blood in the stool was the most common reason for the test, and hemorrhoids and inflammatory bowel disease were the most common diagnoses found
Who was studied
Adults referred for endoscopy at 15 hospitals across Egypt, mostly aged 38-63
Main outcome
Reasons patients were referred for colonoscopy and what the colonoscopy found
Quality
This is a large records review of people already referred for endoscopy for many reasons, not a study designed to find out why healthy people see bright red blood on wiping.
Limitations
Retrospective design using endoscopy referral records; population includes people with many different GI complaints and known liver disease risk, not specifically people with isolated bright red bleeding on wiping; no detail on bleeding pattern (wiping vs mixed in stool) or workup for each case.
Taken word for word from the abstract
- n 5910 patients aged 38-63 were enrolled in the study
- population Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt.
- primaryOutcome Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%).
- result IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients
BMC Gastroenterol · PMID 38807055 · Read it on PubMed ↗
Demb et al. 2024
Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis
Bleeding can signal colon cancer riskMeta-analysisModerate qualityRelated question
24,908,126 people2024
nearly half of patients with early-onset colorectal cancer had reported bleeding (hematochezia) before diagnosis, and this symptom was linked to a 5- to 54-fold higher chance of having colorectal cancer
Who was studied
people under age 50 already diagnosed with colorectal cancer
Main outcome
how often different signs and symptoms (like bleeding, abdominal pain) occurred before diagnosis, and how much they raised cancer risk
Quality
it pools data from 81 studies with formal bias assessment, but it looks backward at people already diagnosed with cancer rather than studying people who present with bleeding of unknown cause.
Limitations
studies included people already diagnosed with colorectal cancer, not people presenting with bleeding whose cause is still unknown, so it cannot show what proportion of bleeding from wiping is due to cancer versus other causes
Taken word for word from the abstract
- population patients younger than age 50 years diagnosed with nonhereditary CRC
- n 81 studies with 24 908 126 patients younger than 50 years were included
- primaryOutcome Outcomes of interest were pooled proportions of signs and symptoms in patients with EOCRC, estimates for association of signs and symptoms with EOCRC risk, and time from sign or symptom presentation to EOCRC diagnosis.
- result hematochezia (pooled prevalence, 45% [95% CI, 40%-50%])
- result Hematochezia (estimate range, 5.2-54.0), abdominal pain (estimate range, 1.3-6.0), and anemia (estimate range, 2.1-10.8) were associated with higher EOCRC likelihood.
JAMA Netw Open · PMID 38787555 · Read it on PubMed ↗
Simão et al. 2026
Colonic polypoid arteriovenous malformation - An unexpected cause of hematochezia
Rare vascular lesion caused severe bleedingCase seriesVery low qualityRelated question
1 people2026
An 8mm abnormal tangle of blood vessels (arteriovenous malformation) in the colon was found causing the severe bleeding, requiring clips, tattooing, and ultimately emergency surgery to remove the colon segment
Who was studied
70-year-old man with severe rectal bleeding and fainting, with history of heart disease and prior radiation injury to the rectum
Main outcome
Cause of the bleeding found on colonoscopy and tissue examination
Quality
This is a single patient case report, so it cannot show how common this cause is or apply broadly to people who just notice blood on wiping.
Limitations
Single case, patient had severe haemorrhage requiring transfusion and surgery, not mild bleeding noticed on wiping; also had unrelated risk factors (radiation proctopathy, coronary disease) that make this atypical.
Taken word for word from the abstract
- population A 70-year-old male was admitted with severe haematochezia and lipothymia. His medical history was relevant for coronary artery disease and radiation proctopathy.
- primaryOutcome Colonoscopy showed an 8mm fibrinous lesion with an adherent clot, at 40 cm from the anal verge.
- result Histopathology report revealed a vascular lesion with arterial and venous vessels, protruding through the submucosa, muscular and subserosa, with a focal mucosal erosion, without neoplastic disease, compatible with an arteriovenous malformation (AVM).
- n A 70-year-old male was admitted
Rev Esp Enferm Dig · PMID 38767028 · Read it on PubMed ↗
Do et al. 2024
Mucosal prolapse syndrome mimicking Peutz-Jeghers syndrome in a pediatric patient
Rare polyp syndrome found in one childCase seriesVery low qualityRelated question
1 people1 year
Repeat colonoscopy a year later showed the polyps were due to mucosal prolapse syndrome, not Peutz-Jeghers syndrome
Who was studied
A 15-year-old boy with painless rectal bleeding
Main outcome
Cause of rectal polyps and bleeding found on colonoscopy and biopsy
Quality
This is a single pediatric case report, so it cannot establish how common this cause is or apply to adults with rectal bleeding of unclear cause.
Limitations
Single case in a child, not an adult; focused on a rare polyp syndrome diagnosis rather than typical bright-red bleeding on wiping with no polyps found.
Taken word for word from the abstract
- population a 15-year-old male who presented with painless rectal bleeding
- n a 15-year-old male
- primaryOutcome A repeat colonoscopy with biopsies a year later revealed a diagnosis of MPS
- result He was found to have four rectal polyps thought to be due to Peutz-Jeghers syndrome. A repeat colonoscopy with biopsies a year later revealed a diagnosis of MPS.
JPGN Rep · PMID 38756112 · Read it on PubMed ↗
Deng et al. 2024
Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients
Not relevant - studies transfusion thresholds in severe hemorrhoid anemiaRetrospectiveLow qualityRelated question
128 people2024
a more restrictive transfusion threshold (keeping hemoglobin below 70 g/L) led to fewer immune transfusion reactions and lower costs than a more liberal transfusion approach, before hemorrhoid surgery
Who was studied
patients with hemorrhoids who developed severe anemia and needed blood transfusion and surgery
Main outcome
preoperative blood transfusion requirements and threshold for severe anemia from hemorrhoids
Quality
this is a retrospective study of a specific surgical population (people already diagnosed with hemorrhoids and severe anemia needing transfusion), not people presenting with bright red bleeding of undetermined cause, so it cannot explain why the symptom occurs.
Limitations
retrospective design; studies only patients with diagnosed hemorrhoids severe enough to cause anemia and require surgery, not the broader population who simply notice blood on wiping; does not address causes of bright red rectal bleeding in general
Taken word for word from the abstract
- population 128 patients with hemorrhoidal severe anemia admitted to 3 hospitals from September 1, 2018, to August 1, 2023
- n included 128 patients with hemorrhoidal severe anemia
- primaryOutcome aimed to evaluate preoperative blood transfusion requirements
- result The LG had a significantly higher transfusion volume (4.77±2.22 units), frequency of immune transfusion reactions (1.22±0.58), and hospitalization costs (16.69±3.31 thousand yuan) than the RG
- result Patients with hemorrhoids with severe anemia might require a lower preoperative transfusion threshold than the currently recognized threshold
Med Sci Monit · PMID 38704632 · Read it on PubMed ↗
Alharbi et al. 2024
Colonic Angiolipoma: A Rare Cause of Chronic Anemia and Rectal Bleeding
Rare tumor caused bleeding.Case seriesVery low qualityRelated question
1 people2024
a rare benign tumor (angiolipoma) in the colon was found to be causing the bleeding and anemia, initially mistaken for hemorrhoids
Who was studied
a 52-year-old woman with chronic intermittent rectal bleeding and anemia, no other health history
Main outcome
underlying cause of chronic rectal bleeding and anemia
Quality
it is a single patient case report, so it cannot tell us how common or likely this cause is for people who notice bright red blood on wiping.
Limitations
single case, rare tumor diagnosed only after colonoscopy and CT scan, not representative of typical bright red bleeding seen on wiping, and bleeding was described as intermittent and associated with anemia rather than isolated bright red blood on toilet paper
Taken word for word from the abstract
- population a 52-year-old woman with no significant medical history who presented with generalized weakness, fatigue, and intermittent, painless rectal bleeding over six months, initially dismissed as hemorrhoidal
- primaryOutcome the diagnostic process identified a 2 cm submucosal lesion in the ascending colon
- result Histopathological analysis following surgical resection confirmed the diagnosis of a colonic angiolipoma.
- n This case involves a 52-year-old woman
Cureus · PMID 38646340 · Read it on PubMed ↗
English et al. 2024
A case of a rare type of cancer: Anal squamous cell carcinoma in a patient without significant risk factors
Rare cancer mimicked hemorrhoid symptomsCase seriesVery low qualityRelated question
1 peopleSeven weeks after starting treatment
The patient's anal squamous cell carcinoma was initially mistaken for a benign condition; the case report notes that anal cancer symptoms can overlap considerably with benign diseases such as hemorrhoids, causing diagnostic delay
Who was studied
A 65-year-old woman with rectal pain and perianal lesions, later diagnosed with anal squamous cell carcinoma
Main outcome
Diagnosis and clinical course of a rare anal cancer that can mimic common benign anorectal conditions
Quality
This is a single case report of a diagnosed cancer patient, which cannot establish how common or likely any particular cause of bright red bleeding is in the general population
Limitations
Single patient case report; the patient already had a rectal mass and lesions and was eventually diagnosed with cancer, not a person with isolated bright red bleeding on wiping and no diagnosis
Taken word for word from the abstract
- population a 65-year-old woman who sought medical attention at the emergency department (ED) due to rectal pain and concurrent rectal lesions persisting for the past three months
- n We present the case of a 65-year-old woman
- primaryOutcome This case report emphasizes the pathogenesis and the similarities in clinical presentation of anal cancer to mild diseases, which may lead to a delay in diagnosis.
- result Patients with anal carcinoma often delay seeking medical care, which is anecdotal in relation to the considerable overlap in symptoms of benign diseases such as hemorrhoids.
- followUp Seven weeks later, she was in remission.
Qatar Med J · PMID 38362253 · Read it on PubMed ↗
Lembo et al. 2024
Clinical Outcomes Before and After Prucalopride Treatment: An Observational Study in Patients With Chronic Idiopathic Constipation in the United States
Less rectal bleeding after constipation treatmentRetrospectiveLow qualityRelated question
690 people6 months before and after prucalopride initiation
the proportion of patients with rectal bleeding fell from 4.1% before prucalopride to 1.7% after starting it, along with reductions in hemorrhoids and other constipation complications
Who was studied
adults with chronic idiopathic constipation who were treated with prucalopride
What they received
prucalopride treatment for chronic idiopathic constipation
Compared with
the same patients' own status in the 6 months before starting prucalopride
Main outcome
rates of constipation-related symptoms and complications, including rectal bleeding, hemorrhoids, and other complications, before versus after treatment
Quality
this is a before-after insurance-claims study without a control group, so it cannot show what causes bleeding on wiping in general and can only suggest an association between treating constipation and fewer recorded bleeding diagnoses.
Limitations
retrospective claims-based design with no untreated comparator group, reliance on diagnosis codes, and a population already selected for being prescribed prucalopride for chronic idiopathic constipation rather than people investigating a new symptom of bright red bleeding on wiping
Taken word for word from the abstract
- population Prucalopride-treated patients (≥18 years old) who had ≥1 constipation-related International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD-10-CM ) diagnosis code during the baseline or study period were included.
- intervention compared constipation-related symptoms and complications 6 months before and after prucalopride initiation
- comparator compared constipation-related symptoms and complications 6 months before and after prucalopride initiation in adults with chronic idiopathic constipation (CIC)
- primaryOutcome The proportions of patients with constipation-related symptoms (abdominal pain, abdominal distension [gaseous], incomplete defecation, and nausea) and constipation-related complications (anal fissure and fistula, intestinal obstruction, rectal prolapse, hemorrhoids, perianal venous thrombosis, perianal/perirectal abscess, and rectal bleeding) were examined.
- result hemorrhoids [10.7% vs 7.0%, P < 0.05]; and rectal bleeding [4.1% vs 1.7%, P < 0.05]
- n This study included 690 patients
Clin Transl Gastroenterol · PMID 38357940 · Read it on PubMed ↗
Gallo et al. 2024
Clinical evidence and rationale of mesoglycan to treat chronic venous disease and hemorrhoidal disease: a narrative review
Drug reduced hemorrhoid bleeding; doesn't explain cause.Narrative reviewLow qualityRelated question
size not given2024
In patients already diagnosed with hemorrhoidal disease, mesoglycan treatment reduced symptom severity and lowered the risk of rectal bleeding, but the review does not explain why bright red bleeding on wiping occurs in the first place.
Who was studied
adults already diagnosed with hemorrhoidal disease or chronic venous disease, not people with new unexplained bleeding on wiping
What they received
oral mesoglycan (a glycosaminoglycan drug)
Compared with
standard postoperative care alone (in the hemorrhoidectomy studies); otherwise not clearly specified
Main outcome
severity of hemorrhoid symptoms, quality of life, and risk of rectal bleeding
Quality
It is a narrative review of a specific drug's treatment effects, not a study explaining the cause of rectal bleeding, and it does not systematically pool evidence on etiology.
Limitations
This is a treatment-focused narrative review in people already diagnosed with hemorrhoidal disease; it does not address people with undetermined-cause bleeding noticed on wiping, nor does it explain the mechanism of bright red bleeding itself.
Taken word for word from the abstract
- population In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding.
- intervention Mesoglycan, a natural glycosaminoglycan (GAG) preparation composed primarily of heparan sulfate and dermatan sulfate
- comparator adding mesoglycan to standard postoperative care reduced pain, improved HRQoL, reduced incidence of thrombosis, and facilitated an earlier return to normal activities/work, compared with standard postoperative care alone
- primaryOutcome mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding
- result In patients with HD, mesoglycan significantly reduced the severity of signs and symptoms and the risk of rectal bleeding.
Updates Surg · PMID 38356039 · Read it on PubMed ↗
Siatecka et al. 2024
A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease
Rare viral infection found inside hemorrhoids.Case seriesVery low qualityRelated question
1 people2024
He had hemorrhoids that were also infected with varicella zoster virus (chickenpox/shingles virus), confirmed by special staining of the removed tissue
Who was studied
a 41-year-old man with ulcerative colitis on adalimumab (an immune-suppressing drug) who had anal lesions
Main outcome
what was causing his anal lesions, found through surgery and tissue examination
Quality
This is a single unusual case report in an immunocompromised patient with a known pre-existing diagnosis, so it says nothing about why a typical person bleeds bright red blood when wiping.
Limitations
Single case; patient was immunocompromised and already diagnosed with hemorrhoids and inflammatory bowel disease, so this does not address an undiagnosed person noticing blood on wiping.
Taken word for word from the abstract
- population a 41-year-old man with a history of ulcerative colitis on adalimumab who presented with anal lesions
- intervention He was diagnosed with hemorrhoids and surgically treated.
- primaryOutcome Microscopic examination confirmed the diagnosis of hemorrhoids.
- result foci of epithelium with viral cytopathic effects were noted. A varicella zoster virus (VZV)-specific immunostain was positive in the areas of interest confirming the diagnosis of the VZV infection limited to the hemorrhoids.
- n a 41-year-old man
Am J Dermatopathol · PMID 38354383 · Read it on PubMed ↗

How we searchedThe exact query, the date it ran, and what came back — so you can run it yourself.

Searched: PubMed · ClinicalTrials.gov · Crossref on 2026-10-26
The exact search — paste this into PubMed to repeat it: ("Gastrointestinal Hemorrhage"[Mesh] OR "rectal bleeding"[tiab] OR "hematochezia"[tiab] OR "blood per rectum"[tiab]) AND ("Hemorrhoids"[Mesh] OR hemorrhoid*[tiab] OR "Fissure in Ano"[Mesh] OR fissure*[tiab] OR "Colorectal Neoplasms"[Mesh] OR polyp*[tiab]) AND ("Differential Diagnosis"[tiab] OR etiology[tiab] OR cause*[tiab] OR diagnosis[tiab]); PubMed expanded that to: ("Gastrointestinal Hemorrhage"[MeSH Terms] OR "rectal bleeding"[Title/Abstract] OR "hematochezia"[Title/Abstract] OR "blood per rectum"[Title/Abstract]) AND ("Hemorrhoids"[MeSH Terms] OR "hemorrhoid*"[Title/Abstract] OR "Fissure in Ano"[MeSH Terms] OR "fissure*"[Title/Abstract] OR "Colorectal Neoplasms"[MeSH Terms] OR "polyp*"[Title/Abstract]) AND ("Differential Diagnosis"[Title/Abstract] OR "etiology"[Title/Abstract] OR "cause*"[Title/Abstract] OR "diagnosis"[Title/Abstract])
What came back: 1968 records found · 197 read · 86 answered the question
Included: Human, animal or laboratory studies reporting an outcome relevant to the question
Excluded: Records about a different condition or intervention
Studies mainly about dark or black stool (melena) from upper GI bleeding
Studies mainly about blood mixed throughout stool rather than on surface or paper
Studies mainly about inflammatory bowel disease flare bleeding as primary focus
Records reporting no outcome
Retracted publications, which are listed but excluded from every count
Limits: Details were read from abstracts, not full papers, so anything reported only in a paper's methods section is not captured here.
Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured.
Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.

1968records came back from the search
197were read
86actually answered the question

Risks and safetyReported side effects and who should be careful.

Cancer and other serious conditions have been mistaken for hemorrhoids and treated as such for months or years before the real cause was found, delaying proper treatment.
Sexually transmitted infections (chlamydia, syphilis) can cause rectal bleeding and inflammation that looks like hemorrhoids or bowel disease on examination, and need different treatment (antibiotics) to clear up.
Embarrassment is a common reason people avoid telling a doctor about rectal bleeding, which can delay diagnosis of a serious cause when one is present.

Why people askWhat brings people to this question.

Hemorrhoids are well known and common, so bright red blood is often assumed to be 'just' hemorrhoids without checking.
Blood that is bright red rather than dark is often (reasonably) taken as a sign it's coming from somewhere low down and minor, like the anus rather than higher in the bowel.
Embarrassment about anal symptoms makes many people hope it will go away rather than mention it to a doctor.
Fear of what a serious diagnosis might mean can make people delay getting it checked, even when they are worried.

Common questionsShort answers, drawn from the same studies.

Why does my bum bleed when I wipe?: The most common reason found in studies of people investigated for this is hemorrhoids (swollen veins around the anus), which showed up in about a third of people who had a colonoscopy for rectal bleeding. Less often, the cause was a tumour, bowel inflammation, or nothing visible at all, so it's worth getting checked rather than guessing.
When I wipe my bum I feel a lump — what is that?: No study in this review specifically tracked people who felt a lump when wiping, so there's no solid figure for what it usually turns out to be. Hemorrhoids commonly feel like a lump and are the most frequently found cause of bleeding overall, but a lump alongside bleeding is a reason to have it examined rather than assumed.
Is bright red blood on the paper ever something serious?: Yes, sometimes. Across different studies, a tumour or bowel inflammation explained the bleeding in roughly 1 in 10 to 1 in 40 people investigated, depending on the population studied. Warning signs that make a serious cause more likely include dark red (not bright red) blood, blood mixed into the stool rather than just on the paper, ongoing pain, or unexplained weight loss.
How is blood from hemorrhoids different from blood from cancer?: One review found that bright red surface blood is more typical of hemorrhoids, while dark red blood, persistent anal pain, and unintentional weight loss were flagged as more suggestive of cancer. The same review noted that cancer is sometimes misdiagnosed as hemorrhoids, so these clues help but don't replace an actual exam.
Should I just wait and see if it stops?: No study followed people with unexplained bleeding over time to see how many it resolved on its own, so there's no evidence that waiting is safe. If bleeding continues, keeps coming back, or comes with pain, a lump, or weight loss, have it examined rather than wait.

What has changedEvery re-check, and whether it changed the answer.

2026-10-26
Clear the 'Under re-review' backlog: rebuild every remaining first-method (ev-1) page under the current method. 70 new studies · 79 no longer retrieved · evidence strength moderate → low · conclusion signal of harm → not applicable.
How certain we are changed. The conclusion changed.

This is information, not advice

This page summarises published research. It cannot tell you what is happening in your own body, and evidence changes. If something is bleeding, painful, or new, it is worth being looked at — that is a different question from the one on this page, and a better one to bring to a consultation.

Contact the office

Automated evidence review — PubMed, ClinicalTrials.gov, Crossref. Search strategy, grading rules and the checks that must pass before anything publishes were written by Allen Kamrava, MD, MBA, FACS, FASCRS, colon & rectal surgery, Beverly Hills. The pages themselves are compiled by software running that method and are not read one by one before publication — saying otherwise would be the one claim here that could not be checked.

Allen Kamrava, MD, MBA, FACS, FASCRS · 435 N. Bedford Dr., Suite 308, Beverly Hills, CA 90210 · 424.279.8222

Educational information — not medical advice.