Occasionally seeing blood on toilet paper is quite common. This sign, in itself of little concern, is typical of various pathologies, some of which are very serious. Although a proctological examination is still advisable, the patient can get an idea of the problem that afflicts him by examining the characteristics and any signs and symptoms associated with the bleeding. Let's see some examples:
- anal fissures: these small cuts in the anal mucosa are the most frequent cause of blood on toilet paper. In this case, the bleeding is very limited and more than real drops of blood, thin bright red streaks are observed which are attenuated with the various passages of the toilet paper. Anal fissures, which normally cause acute anal pain during the defecation and intimate hygiene can be prevented and defeated through careful intimate hygiene, and with the regularization of intestinal activity in case of diarrhea or constipation
- hemorrhoids: they are dilations of the homonymous submucosal veins at the level of the anus and the terminal tract of the rectum. In this case, the bleeding tends to be more abundant and the blood on the toilet paper creates real stains; sometimes you can even observe a blood dripping in the internal walls of the toilet or a paint of blood on the last stool emitted. Hemorrhoidal bleeding is usually painless, but in severe cases it can be associated with mucus loss, irritation, pain and itching
- colorectal polyps or carcinomas: in this case the blood is mixed with the faeces, unfortunately often in a way not visible to the naked eye and without associated symptoms (for this reason, in the screening of colorectal cancer, after the age of 50 the so-called search for occult blood in the stool). In the case of large polyps, the faeces take on a ribbon-like appearance and the persistence of the evacuative stimulus is common even after defecation. Moderate abdominal pain, anemia, poor appetite, fatigue, tiredness, dyspnoea, weight loss, blood in toilet paper, diarrhea, and constipation may lead to suspicion of colorectal cancer
- ulcerative colitis: chronic inflammatory bowel disease, often characterized by the emission of diarrheal stools with traces of mucus and blood; more rare is the finding of blood in the stool in a subject with Crohn's disease
- diverticular disease: small sacs (diverticula), which especially in old age form along the intestinal walls of some subjects, can become inflamed and rarely cause sudden abundant bleeding in the absence of pain, even with clot emissions but often without stool emission
- peptic ulcer: ulcerations of the gastric and duodenal mucosa cause hemorrhages that occur - among other things - with the emission of digested blood in the faeces (melaena), characterized by a particularly dark color and tarry consistency
- food diseases: food poisoning (salmonella, Escherichia coli, shigella ...) are typically accompanied by pain and abdominal cramps with violent diarrheal discharges, sometimes mixed with blood and mucus (expression of damage to the intestinal mucosa)
- venereal diseases: such as gonorrhea, chlamydia, genital herpes, syphilis, trichomoniasis contracted through unprotected sexual intercourse of a mainly anal nature
- iatrogenic bleeding: radiation therapy in the treatment of pelvic tumors, abuse of laxative drugs such as bisacodyl, or antidiarrheal drugs, and prolonged antibiotic therapies, especially with lincomycin and clindamycin, can cause rectal bleeding.
PLEASE NOTE: it is good practice that any perceived rectal bleeding, even if minor and limited to the presence of blood in the toilet paper, is subjected to the attention of your doctor, especially in the case of over 45 years of age or familiarity due to polyposis and colorectal cancers.
