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How to Determine if It's Rectal Bleeding or Hemorrhoids

Jul 02, 2025 Source: Cainiu Health
Dr. Li Jingxiang
Introduction
Determining whether the bleeding is from the rectum or hemorrhoids generally involves analysis of the bleeding site, blood color, accompanying symptoms, digital rectal examination, and colonoscopy. Hemorrhoidal bleeding typically originates from the hemorrhoidal venous plexus near the dentate line of the anal canal, with the bleeding site located close to the anus. Rectal bleeding arises from the rectal mucosa or blood vessels in the upper part of the intestinal tract, which is relatively farther from the anus.

Determining whether the bleeding is from the rectum or hemorrhoids typically involves diagnosis based on the bleeding site, blood color, accompanying symptoms, digital rectal examination, and colonoscopy. If any abnormalities are detected, timely medical consultation is recommended. Detailed analysis is as follows:

1. Bleeding Site: Hemorrhoidal bleeding originates mostly from the hemorrhoidal venous plexus near the dentate line of the anal canal, with the bleeding site close to the anus; rectal bleeding originates from the rectal mucosa or blood vessels, located in the upper part of the intestine, relatively farther from the anus.

2. Blood Color: Hemorrhoidal bleeding usually appears bright red since the blood has not remained in the intestine for long. It commonly manifests as dripping blood, blood on toilet paper, or even blood spraying during defecation. Rectal bleeding may appear dark red or black if the blood has remained in the intestine for a prolonged period, but it can also appear bright red if the bleeding is rapid.

3. Accompanying Symptoms: Hemorrhoidal bleeding is often accompanied by anal pain and prolapse of hemorrhoids, with pain intensifying during bowel movements. In severe cases, manual repositioning of the prolapsed hemorrhoids may be required. Rectal bleeding may be accompanied by abdominal pain, diarrhea, changes in bowel habits, and some patients may experience mucus-filled or pus-filled stools mixed with blood.

4. Digital Rectal Examination: Digital rectal examination can aid in diagnosis. Patients with hemorrhoids may have soft, smooth-surfaced hemorrhoids felt during the examination. If rectal bleeding is caused by inflammation, ulceration, or tumors, the examination may reveal rough rectal mucosa, nodules, or masses, and the glove may be stained with blood or mucus.

5. Colonoscopy: Colonoscopy can determine the exact cause. Under colonoscopy, patients with hemorrhoids show congested and dilated hemorrhoidal venous plexus in the anal canal. Patients with rectal bleeding show visible lesions in the rectal mucosa such as inflammation, ulcers, polyps, or tumors, allowing precise localization of the bleeding site and assessment of the lesion characteristics.

Do not ignore any symptoms of bleeding; timely medical attention is essential. When seeking medical care, provide a detailed description of the color and amount of blood, as well as any accompanying symptoms. Cooperate with the doctor to complete digital rectal examinations, colonoscopies, and other necessary tests.

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