Bright red blood in stool—why do some people ignore it for years?

Bright red blood in stool—why do some people ignore it for years?

Noticing bright red blood in your stool can be alarming. Yet many people put off seeking medical care—even when this happens repeatedly. Understanding the reasons behind this delay, the possible causes of bleeding, and when to act can help you take control of your health.

Why people dismiss bright red blood in stool
Many factors—emotional, practical, and cultural—lead individuals to ignore rectal bleeding:

• Attributing it to hemorrhoids
– Hemorrhoids are common, often benign, and can cause bright red blood on toilet paper or in the bowl.
– Once diagnosed in the past, people may assume any future bleeding has the same harmless origin.

• Embarrassment and stigma
– Talking about bowel habits feels awkward.
– Fear of judgment can discourage discussing symptoms with friends, family or a doctor.

• Denial and normalization
– Bleeding may be intermittent, mild, and painless, so people normalize it as not serious.
– “It’ll go away on its own” becomes a default mindset.

• Fear of a serious diagnosis
– Anxiety about colon cancer or inflammatory bowel disease can lead to avoidance.
– Avoiding the doctor delays confirmation—good or bad—prolonging stress.

• Limited access or cost concerns
– Lack of insurance, high co-pays or time off work can be barriers to medical care.
– Remote locations or transportation issues add to the challenge.

Possible causes of bright red blood in stool
Bright red blood indicates bleeding close to the anus. Causes range from minor to significant:

• Hemorrhoids
– Swollen veins in the anal canal.
– Can itch, burn or be sore, but often painless.

• Anal fissures
– Small tears in the lining of the anus, often from passing hard stool.
– Sharp pain during bowel movements; bright red blood on toilet paper.

• Diverticular bleeding (Diverticulosis)
– Pouches (diverticula) form in the colon wall, occasionally bleeding.
– Can be sudden and heavy but often stops on its own.

• Colorectal polyps or cancer
– Growths on the lining of the colon or rectum may bleed.
– Early cancers can cause chronic, low-grade bleeding without pain.

• Inflammatory bowel disease (IBD)
– Ulcerative colitis and Crohn’s disease inflame the intestinal lining.
– Blood may mix with mucus; often accompanied by diarrhea and cramps.

• Infectious colitis
– Bacterial, viral or parasitic infections inflame the colon.
– Diarrhea, fever and abdominal pain may be present.

• Angiodysplasia
– Fragile blood vessels in the colon can bleed intermittently.
– More common in older adults; bleeding is often painless.

When to seek medical care
According to the ACG clinical guideline on acute lower gastrointestinal bleeding (Strate & Gralnek, 2016), any instance of red blood in stool warrants evaluation to rule out serious conditions. Seek prompt care if you experience:

• Heavy bleeding or dizziness
• Rapid heart rate or low blood pressure
• Severe abdominal pain or cramping
• Fever or chills
• Changes in bowel habits lasting more than a week
• Unexplained weight loss or fatigue

What to expect during evaluation
Your doctor will tailor tests based on symptoms and risk factors:

• Medical history and physical exam
– Discuss family history of colorectal cancer or polyps.
– Digital rectal exam to assess hemorrhoids or masses.

• Laboratory tests
– Complete blood count to check for anemia.
– Liver function tests—especially if you have known liver disease or cirrhosis (Tsochatzis & Bosch, 2014).

• Endoscopic procedures
– Colonoscopy is the gold standard to visualize the entire colon and remove polyps.
– Flexible sigmoidoscopy examines the lower colon for sources of bleeding.

• Imaging studies
– CT angiography can identify active bleeding, especially in diverticular disease.
– Tagged red blood cell scans locate slower bleeding sites.

• Noninvasive predictive indices
– Certain blood-test-based scores (Sterling & Lissen, 2006) can help assess bleeding severity and need for intervention.

Treatment options
Treatment depends on the underlying cause:

• Hemorrhoid therapies
– Dietary fiber, sitz baths, topical ointments or rubber-band ligation.
• Anal fissure care
– Stool softeners, warm baths and topical nitrates.
• Endoscopic interventions
– Polyp removal, cauterization or clipping of bleeding vessels.
• Surgery or embolization
– For uncontrolled bleeding from diverticula or angiodysplasia.
• Medications for IBD
– Anti-inflammatories, immunosuppressants or biologics.
• Antibiotics for infections
– Targeted to the specific pathogen identified.

Why early detection matters
• Prevent complications
– Chronic blood loss can lead to anemia, fatigue and weakened immunity.
– Large bleeds can become life-threatening without timely care.

• Detect cancer early
– Colorectal cancer often begins as benign polyps.
– Removing polyps during colonoscopy prevents progression to cancer.

• Improve outcomes
– Early treatment of IBD or diverticular disease reduces hospitalizations.
– Managing hemorrhoids or fissures promptly alleviates discomfort and anxiety.

Taking the next step
Ignoring bright red blood in stool can allow serious conditions to progress. If you’ve been putting off evaluation:

• Keep a symptom diary
– Note frequency, amount of blood, stool consistency and related symptoms.
• Talk openly with your healthcare provider
– Honesty helps guide the right tests and treatments.
• Consider doing a free, online symptom check for to gather questions and possible causes before your appointment.

Remember, early medical attention can make a major difference in your health. If you notice bright red blood in your stool—even once—speak to a doctor about anything that could be life threatening or serious. Your well-being is worth the conversation.