Observing bright red blood on the paper or in the toilet bowl is a common cause for concern and referral to a gastroenterologist. However bright red blood usually has a benign cause such as haemorrhoids or anal fissure , and less commonly due to inflammatory bowel disease.
The risk of bowel cancer as a cause or bleeding is most strongly related to age of the patient, but it is important to investigate most patients. A shorter duration of bleeding (less than 6months) and blood mixed with the stool are slightly more associated with a serious cause.
Dark red or black stools suggest bleeding from higher in the bowel or from the upper gastrointestinal tract and would also require investigation. Most patients will need to proceed to colonoscopy.
