Symptom guide
Blood on toilet paper: causes, red flags and when to get it checked
A little bright red blood on the paper after wiping is usually from piles (haemorrhoids) or a small tear in the anal skin (fissure). It is common and often settles with simple measures. Because bowel cancer and inflammatory bowel disease can also cause rectal bleeding, persistent bleeding or bleeding with a change in bowel habit should be assessed.
Last checked: 2026-10-03
Key facts
At a glance.
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Most common
Haemorrhoids and anal fissures cause most cases of bright red blood on paper.
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Fissure clue
Sharp, burning pain on passing stool with a little bright blood suggests a fissure.
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Piles clue
Painless bright red blood, sometimes dripping into the pan or with a lump that comes out, suggests haemorrhoids.
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Check if
Persistent bleeding, over 50, bowel habit change, weight loss, anaemia or dark mixed-in blood.
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Who to see
GP; colorectal surgery or gastroenterology for investigation or treatment.
What this symptom usually means
The bottom of the bowel and the anal canal have a rich blood supply. Straining or passing hard stool can stretch or tear the lining, and swollen cushions of veins (haemorrhoids) bleed easily. The colour and mix of blood are informative: bright red blood on the paper or surface of the stool suggests the lowest part of the bowel.
Possible causes, from most to least common
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Haemorrhoids (piles): painless bright red blood, itching, a lump that may come out and go back in.
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Anal fissure: a small tear causing sharp pain during and after bowel movements, with a streak of blood.
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Constipation and straining, or frequent diarrhoea irritating the skin.
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Proctitis or inflammation of the rectum, including inflammatory bowel disease, with blood, mucus and urgency.
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Diverticular disease, which can bleed painlessly and sometimes heavily.
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Colorectal polyps and bowel cancer: blood mixed with stool, a change in bowel habit, weight loss, tiredness or anaemia.
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Anal infection, warts or fistula, and radiation proctitis after pelvic radiotherapy.
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Anal cancer, which is rare, with a persistent lump, pain or bleeding.
Features that point to something more serious
Blood mixed with stool or dark, persistent bleeding over several weeks, a change in bowel habit, unexplained weight loss, tiredness or iron deficiency anaemia, abdominal pain or mass, age over 50, and a family history of bowel cancer warrant prompt review.
Red flags: when to seek help
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Call 999 or go to A&E: heavy bleeding, passing large clots, dizziness or fainting.
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Urgent GP referral: bleeding with a change in bowel habit lasting over six weeks, weight loss, or anaemia, particularly over 50.
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GP within days to weeks: bleeding that recurs for more than a couple of weeks, or severe anal pain.
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Pharmacist or routine GP: a little blood on the paper with constipation, with no other symptoms.
What a doctor will ask and examine
The doctor asks how long, how much, colour, mix with stool, pain, bowel habit, weight change, family history and medicines such as blood thinners. They examine the anus visually and perform a rectal examination and sometimes a short camera test (proctoscopy).
Tests that are commonly used and why
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Full blood count and ferritin: for anaemia.
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Proctoscopy or flexible sigmoidoscopy: to see haemorrhoids, fissures and the lower bowel.
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FIT test and colonoscopy: for suspected bowel cancer or persistent bleeding with risk factors.
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Faecal calprotectin: if inflammatory bowel disease is suspected.
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CT colonography: an alternative to colonoscopy in selected people.
Self-care and the usual route
Increase fibre and fluids to soften stools, avoid straining and prolonged sitting on the toilet, and clean gently with water or moist wipes rather than rough paper. Over-the-counter creams and suppositories can ease symptoms, and a pharmacist can advise. Topical treatments for fissures are available on prescription.
The NHS route is a GP, then colorectal surgery for haemorrhoid banding or surgery, and colonoscopy if needed. Private colorectal clinics offer direct access to examination, banding and endoscopy.
Frequently asked
Questions people ask.
Quick, plain-English answers to the questions we hear most.
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Is blood on toilet paper normal?
It is common and usually from piles or a fissure, but persistent or unexplained bleeding should be checked.
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What is the difference between piles and a fissure?
Piles typically bleed painlessly, while fissures cause sharp pain during and after passing stool.
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Could it be bowel cancer?
Uncommon in someone with typical piles, but persistent bleeding with change in bowel habit, weight loss or anaemia needs investigation.
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Do I need a colonoscopy?
If bleeding is persistent, you are over 50, have red flags or an abnormal stool test, a colonoscopy is commonly advised.
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What helps piles?
Fibre, fluids, avoiding straining, and topical treatments. Banding or other procedures treat persistent cases.
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How do I treat a fissure?
Soften stools, use topical treatments such as glyceryl trinitrate or diltiazem ointments prescribed by a doctor, and consider procedures for chronic fissures.
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Can blood thinners cause rectal bleeding?
They can increase bleeding from piles or other sources, but bleeding should still be investigated.
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Is dark blood different?
Dark or maroon blood mixed with stool suggests bleeding higher in the bowel, while black tarry stool suggests the stomach or upper gut.
Where this comes from
Sources and checking.
This guide is for information, not medical advice.
Your GP or consultant knows your history and can tell you which parts apply to you. If your symptoms are severe, rapidly worsening, or come with red-flag features, seek urgent medical care. Figures and availability change, so treat them as a guide and confirm with the provider.
Published 2026-10-03, next review 2027-10-03.
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NHS: Piles (haemorrhoids) (nhs.uk/conditions/piles-haemorrhoids/)
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NHS: Anal fissure (nhs.uk/conditions/anal-fissure/)
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NICE guideline NG12: Suspected cancer - recognition and referral