Blood When Wiping: Hemorrhoids, Fissure, or Something More Serious?

Finding bright red blood on the toilet paper after wiping can be alarming. In most cases, this symptom—often described as “blood when wiping”—is caused by minor, easily treated conditions such as hemorrhoids or anal fissures. However, sometimes it may signal a more serious issue. This guide explains common causes, how to tell them apart, and when to seek medical attention.

Common Causes of Blood When Wiping

1. Hemorrhoids
2. Anal fissures
3. More serious conditions (polyps, inflammatory bowel disease, colorectal cancer)

Each has characteristic signs. Understanding these can help you decide whether home treatment is sufficient or a doctor’s visit is needed.

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1. Hemorrhoids

Hemorrhoids are swollen veins in and around the anus or lower rectum. They’re very common—up to 50% of adults experience them at some point.
(Source: Riss S et al., 2012)

Symptoms

• Bright red blood on toilet paper or dripping into the toilet
• Itching, irritation, or pain around the anus
• A lump near the anus (may be tender or painful if thrombosed)
• Mucus discharge

Types

• Internal hemorrhoids: Inside the rectum; usually painless but may bleed.
• External hemorrhoids: Under the skin around the anus; can be painful, especially if a blood clot forms.

Treatment

• Warm sitz baths (10–15 minutes, 2–3 times daily)
• Over-the-counter creams or suppositories with hydrocortisone
• High-fiber diet and plenty of fluids to soften stool
• Avoid straining during bowel movements

Most cases improve within a week or two. If bleeding is heavy, persistent, or accompanied by severe pain, medical procedures (rubber band ligation, sclerotherapy, or hemorrhoidectomy) may be considered.

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2. Anal Fissures

An anal fissure is a small tear in the lining of the anus, often caused by passing hard or large stools.
(Source: Nelson RL et al., 2007)

Symptoms

• Sharp, burning pain during and after bowel movements
• Bright red blood on toilet paper or stool surface
• A visible crack or tear in the skin around the anus
• Possible muscle spasms of the anal sphincter

Treatment

• Warm sitz baths to relax the sphincter and improve blood flow
• Topical treatments (nitrate or calcium-channel blocker creams) to reduce sphincter pressure
• High-fiber diet and fiber supplements
• Stool softeners (e.g., docusate)

Most fissures heal within 6–8 weeks with conservative measures. If they become chronic, a minor surgical procedure (lateral internal sphincterotomy) may be recommended.

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3. Something More Serious

While hemorrhoids and fissures account for the majority of painless bleeding, other conditions can cause “blood when wiping.” These require prompt evaluation.

a. Colorectal Polyps and Cancer

• Polyps are benign growths that can bleed. Some may develop into cancer over time.
• Colorectal cancer can present with:
  • Bright red or dark blood on stool surface
  • Changes in bowel habits (diarrhea, constipation)
  • Unexplained weight loss or fatigue

Screening colonoscopies reduce risk by identifying and removing polyps early.

b. Inflammatory Bowel Disease (IBD)

• Ulcerative colitis and Crohn’s disease can cause rectal bleeding.
• Other signs: abdominal pain, diarrhea (sometimes with blood or mucus), weight loss.

c. Diverticular Disease

• Small pouches (diverticula) in the colon wall can sometimes bleed.
• Bleeding is often painless but may be heavy.

d. Infectious Colitis

• Bacterial or viral infections of the colon may cause bloody diarrhea, cramping, and fever.

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How to Tell the Difference

While only a healthcare professional can make a definitive diagnosis, these features can help you distinguish common causes at home:

Feature	Hemorrhoids	Anal Fissure	More Serious Causes
Pain	Mild to none (internal)	Sharp, burning	Varies (often none)
Location of bleeding	Surface of stool/tp	Surface of stool/tp	May be mixed with stool
Stool consistency	Normal to slightly hard	Often hard	Often loose (IBD, infection)
Visible lump or tear	Possible lump	Tear in skin	Not typical
Additional symptoms	Itching, mucus discharge	Spasm, soreness	Bowel habit changes, weight loss, fever

(tp = toilet paper)

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When to See a Doctor

Although minor bleeding often resolves with home care, see a healthcare professional if you experience:

• Bleeding that’s heavy or doesn’t improve after 1–2 weeks of treatment
• Black, tarry stools (may indicate bleeding higher in the digestive tract)
• Severe abdominal pain or cramping
• Unexplained weight loss, fever, or diarrhea lasting more than a few days
• A change in bowel habits (new constipation or diarrhea)
• A family history of colorectal cancer or inflammatory bowel disease

If you’re unsure, you might consider doing a free, online symptom check for to help decide your next steps.

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Tips to Reduce Risk and Promote Healing

• Eat a high-fiber diet: fruits, vegetables, whole grains, beans
• Drink plenty of water (at least 8 glasses per day)
• Exercise regularly to promote healthy bowel function
• Avoid prolonged sitting on the toilet
• Respond promptly to the urge to have a bowel movement

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Conclusion

“Blood when wiping” is a worry for many, but most often it’s due to hemorrhoids or an anal fissure—both treatable with home care. Paying attention to accompanying symptoms (pain level, stool changes, additional signs) can help you decide if simple remedies are enough or if a doctor’s evaluation is needed.

Always seek professional advice if bleeding is heavy, persistent, or accompanied by severe pain or other concerning symptoms. Early diagnosis of more serious conditions, such as colorectal cancer or inflammatory bowel disease, can significantly improve outcomes.

Speak to a doctor about any bleeding that could be life threatening or serious.