Rectal bleeding is an important symptom that shouldn’t be overlooked. There are many different conditions that can lead to rectal bleeding, and it’s important to be able to recognize when you may need to seek medical assistance.

Causes of rectal bleeding

Some of the causes of rectal bleeding include:

Gonorrhea
Chlamydia
Human papillomavirus (HPV)
Syphilis
Chancroid
Herpes
Rough sexual activity
Inflammatory bowel disease
Hemorrhoids

Sexually transmitted infections

Many instances of rectal bleeding can be caused by undiagnosed sexually transmitted infections (STIs). Anorectal STIs are more prevalent in women who engage in anal sex, and men who have sex with men.

Gonorrhea

Gonorrhea, caused by Neisseria gonorrhoeae, can be spread through vaginal, anal, and oral sex. In addition to affecting the genitals, mouth, and rectum, it can also spread to the joints, heart valves, skin, and other organs. When it passes from mother to child during delivery, it can also affect the baby’s eyes.

According to a study published by the World Journal of Gastroenterlogy, symptoms of anal gonorrhea include:

Anal pain
Tenesmus or ineffective straining to defecate
Urgency to defecate
Purulent discharge
Rectal bleeding
Ulcerations

Chlamydia

Chlamydia, caused by Chlamydia trachomatis, is another common STI that can affect the rectum. In fact, according to an interesting fact published by Clinics in Colon and Rectal Surgery, co-infection with chlamydia and gonorrhea is common.

Symptoms of anal chlamydia include:

Swollen rectal mucosa
Rectal bleeding and discharge
Cramping
Perirectal abscesses and/or ulcers
Rectal fistulas

Human papillomavirus (HPV)

HPV is a virus with many different strains. Some strains are high-risk for many different types of cancer, whereas others are more likely to lead to warts, which can affect the anus.

HPV warts resemble small cauliflowers, are flesh-colored, and can cause rectal bleeding. Despite the fact that strains that cause warts aren’t high-risk for cancer, they still represent a risk factor for anal cancer, according to the American Cancer Society. This is because people who are infected with strains that cause warts are also more likely to be unknowingly infected with high-risk strains of HPV.

Other STIs that can cause rectal bleeding

Syphilis
Chancroid
Herpes

Sexual activity

The skin and mucous membranes of the anus and rectum are very delicate, since they don’t typically stretch much and can’t produce their own natural lubrication.

Attempting to engage in anal sex without proper lubrication, or by taking things too fast, can result in microtears to the anal mucosa. These small injuries can bleed, hurt, or become infected. Microtears also increase the risk of contracting an STI, since they provide an opening for microorganisms to enter your body.

Non-STI causes

Inflammatory bowel disease

Inflammatory bowel disease (IBD) encompasses Crohn’s disease and ulcerative colitis. These diseases cause chronic inflammation of parts of the digestive tract, which can manifest through bloody diarrhea and rectal bleeding. According to the Mayo Clinic, other symptoms can include unintended weight loss, fatigue, and abdominal pain and cramping.

Hemorrhoids

According to the Cleveland Clinic, hemorrhoids are veins inside the rectum that can become swollen and enlarged. When this happens, hemorrhoids can protrude outside of the anus, and cause pain and rectal bleeding.

Hemorrhoids can also cause:

Rectal itching
Sore, hard lumps around the anus
Pain when you sit down

When to go to the doctor for rectal bleeding

Rectal bleeding is a rare occurrence, and you should seek medical assistance if it lasts for more than 1 or 2 days, or if it’s accompanied by any other symptoms. In some cases, rectal bleeding can be caused by small, non-infectious lesions — typically after anal intercourse or after passing hard stools — that resolve on their own.

But if you have experienced any accompanying symptoms, or your bleeding doesn’t resolve, it’s time to call your doctor. Your healthcare provider will be able to provide an accurate diagnosis and prescribe the treatment that you need to prevent complications.

Treatment for rectal bleeding

The treatment for rectal bleeding will depend entirely on what is causing it, which is why it’s so important to get an accurate diagnosis from your doctor.

Gastrointestinal issues, such as inflammatory bowel disease, are typically managed through a combination of diet and medications. Hemorrhoids can be managed through lifestyle changes and topical medications, although severe cases can require surgical treatment.

STIs that cause rectal bleeding are also treated with antibiotics. Keep in mind that the right antibiotic therapy will vary depending on which is the pathogen causing the infection — you should never try to self-medicate if you suspect that you may have an STI.

If your doctor prescribes antibiotics, it’s important to complete the full course of the medication according to their instructions. Cutting your treatment short could lead to a recurrence, and it can also increase antibiotic resistance.

Warts caused by HPV, specifically, can be treated using prescription topical creams. According to the Mayo Clinic, they can also be removed using different methods, including freezing them with liquid nitrogen (cryotherapy), electrocautery, laser, or surgical excision.

If you experience rectal bleeding or pain as a result of sexual activity, you should stop immediately. Rectal fissures or lesions can become infected and lead to discomfort. When you engage in anal sexual activity again, remember to use as much lubricant as needed (avoid oil-based lubricants to prevent damaging latex condoms) and go slowly. Sexual activity should be comfortable and pleasurable for all parties involved!

Written by Andrea Pinto on June 24, 2021