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Passing blood during bowel movements, painless, bright red, what's the reason?

Mar 20, 2025 Source: Cainiu Health
Dr. Li Jingxiang
Introduction
Consuming large amounts of spicy foods, such as chili peppers and Sichuan peppers, or excessive alcohol intake within a short period can irritate the intestinal mucosa, causing congestion and possibly leading to painless rectal bleeding with bright red blood during bowel movements. It is recommended to adjust your diet by avoiding spicy and irritating foods, and increasing consumption of vegetables and fruits, such as bananas and spinach. Long-term constipation with hard, dry stools and excessive straining during bowel movements can cause anal skin tears, resulting in rectal bleeding.

Passing blood during defecation refers to hematochezia. Hematochezia without pain and with bright red blood may be caused by dietary factors, constipation, internal hemorrhoids, anal fissures, or ulcerative colitis. Appropriate management can be selected based on specific circumstances. If discomfort occurs, it is recommended to seek timely medical attention at a hospital, clarify the condition, and follow medical advice for treatment to avoid delaying the illness.

1. Dietary factors: Consuming large amounts of spicy foods such as chili peppers and Sichuan peppercorns or excessive alcohol intake within a short period may irritate the intestinal mucosa, causing congestion and hematochezia during defecation. The blood is bright red and painless. Adjustments to the diet are recommended, avoiding spicy and irritating foods, and increasing intake of vegetables and fruits such as bananas and spinach.

2. Constipation: Long-term constipation with dry, hard stools can cause anal skin tears due to excessive straining during bowel movements, resulting in hematochezia. Due to the nerve distribution characteristics of the anal skin, there is often no significant pain, and the blood appears bright red. In daily life, dietary fiber intake should be increased, more whole grains such as corn and oats should be consumed, 1500-2000 ml of water should be drunk daily, and moderate exercise should be performed to promote intestinal motility.

3. Internal Hemorrhoids: Prolonged sitting or constipation may lead to congestion and swelling of the venous plexus at the lower end of the rectum or anal canal, forming internal hemorrhoids. The mucosa of internal hemorrhoids may easily get damaged during defecation, causing painless bright red hematochezia. In severe cases, the hemorrhoidal mass may prolapse. Patients may use medications such as Ma Ying Long Musk Hemorrhoid Ointment, Huazhi suppository, and Diosmin tablets under medical guidance to alleviate hematochezia.

4. Anal Fissure: Anal fissures are commonly caused by injury to the anal mucosa from hard stools passing through the anus. The amount of bleeding is usually small, with bright red blood found on the surface of the stool or dripping into the toilet bowl. Severe pain during defecation may occur, sometimes accompanied by constipation and itching. It is recommended to use medications such as lactulose oral solution, lidocaine hydrochloride gel, and Ma Ying Long Musk Hemorrhoid Ointment under medical guidance to relieve discomfort.

5. Ulcerative Colitis: Ulceration of the colonic mucosa caused by autoimmune disorders, infections, and other factors may involve the rectum, potentially causing hematochezia with bright red blood, accompanied by symptoms such as abdominal pain, diarrhea, and mucopurulent bloody stools. Follow medical advice to use medications such as sulfasalazine enteric-coated tablets, mesalazine enteric-coated tablets, and prednisone acetate tablets to improve symptoms.

In daily life, it is recommended to develop regular bowel habits, avoid prolonged squatting, alleviate constipation, and reduce hematochezia.

References:

[1] Li Zhenzhen, Zhao Feifei. Clinical observation of Liangxue Dihuang Decoction combined with Maziren Pills plus or minus combined with Puji Hemorrhoid Suppository in the treatment of chronic anal fissure[J]. Harbin Medicine, 2025, 45(01): 118-121.

[2] Zhang Rugang, Nie Yan, Qi Xin, et al. Effect of cap-assisted endoscopic injection of polidocanol solution on bleeding internal hemorrhoids[J]. Journal of Clinical Digestive Diseases, 2025, 37(01): 20-23.

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