Should I use this page, or skip it?
Use this page if you have seen blood in the toilet or on the paper and need to know whether to book a GP or call 999. Skip it and call 999 for heavy bleeding, collapse, or black tarry stool if you feel very unwell. This page cannot tell piles from bowel cancer.
Unexplained rectal bleeding in adults is 2-week-wait territory with a GP. Do not wait for a screening kit to arrive, and do not assume cream from the chemist has answered the question.
What might the blood look like?
Bright red blood on the paper, dripping into the bowl, or coating the stool often comes from the anus or lower rectum. Haemorrhoids and fissures are common in that pattern. Blood mixed through the stool, or maroon stool, still needs investigation rather than a guess from the colour alone.
Black, sticky, foul-smelling tar-like stools can mean bleeding higher in the gut. If you feel faint or very unwell with that, it is 999, not a cream from the chemist. Describe whether the blood is on the surface or mixed — that detail helps the GP.
What commonly causes it?
Piles are swollen veins that bleed bright red, often with itching or a lump. A fissure is a small tear that stings as stool passes, often with constipation. Diverticular pouches, ulcerative colitis or Crohn’s, polyps, and bowel cancer can also bleed. Several of those can coexist.
Irritable bowel syndrome does not usually cause blood. If you have been told you have IBS and then see blood, that is a new problem. Iron-deficiency anaemia with bleeding is a reason to investigate, not to take iron and forget it.
Why does a GP need to see unexplained bleeding?
Because piles and cancer can look the same from the toilet bowl. In adults, unexplained rectal bleeding is assessed with cancer in mind and may be referred on a 2-week-wait pathway. That is a speed of assessment, not a verdict, and it exists so people are not left hoping it was “just piles”.
A GP may examine you, arrange blood tests, and refer for colonoscopy or another camera test. Take a list of medicines, including blood thinners and ibuprofen. Embarrassment is normal; this is routine work for GPs.
What about screening kits?
Bowel screening looks for hidden blood using a home FIT kit. In England, people are currently invited from ages 50 to 74. You will be invited according to your UK nation’s programme — ages and timing are not identical everywhere. Complete the kit when it arrives rather than leaving it on the fridge.
A positive kit needs follow-up. It does not mean cancer. Visible blood still needs a GP even if your last screening kit was negative. Screening is not a substitute for symptoms, and symptoms are not a reason to skip the kit when it comes.
When is it 111 or 999?
Book a GP for any unexplained blood, including a single episode, rather than waiting to see if it happens again. Use 111 in England, Scotland and Wales if you cannot get a prompt appointment; Northern Ireland uses GP out-of-hours via nidirect.
Call 999 for heavy bleeding, collapse or fainting, severe tummy pain, or black tarry stools if you feel very unwell. Do not drive if you feel faint. Ordinary streaks with known piles still need review if they are new or changing.
Do NHS doors differ across the UK?
Call 111 in England, Scotland and Wales if you need urgent advice and are not in immediate danger; Northern Ireland uses GP out-of-hours via nidirect rather than a general 111 service. Pharmacy schemes and what is free also vary by nation and local area, so ask rather than assuming last year’s rule still applies.
999 is the same emergency number everywhere. A sexual health clinic, GP or pharmacist in any UK nation can still start the right pathway even if the branding of the minor-illness scheme is different. Take a list of medicines and allergies with you.
Who should skip this page?
Skip this page if you are already bleeding heavily or feeling faint — call 999. It is not a piles-cream shopping list, not a screening-age calculator for every nation, and not a cancer diagnosis. If constipation is the only long-term issue and there is no blood, start from constipation instead.
Common questions about blood in poo
- What does blood in poo look like?
- Bright red blood on toilet paper, dripping into the bowl, or coating the stool usually comes from the anus or lower rectum. Dark red blood mixed through the stool needs investigation. Black, sticky, tar-like stools can mean bleeding higher in the gut. Describe the colour and whether it is on the surface or mixed — that helps the GP.
- What are common causes?
- Haemorrhoids (piles) and anal fissures are common and cause bright red bleeding, often with itching or sharp pain on passing stool. Diverticular disease, inflammatory bowel disease, polyps and bowel cancer can also bleed. Piles are common, but they should be diagnosed rather than assumed, especially if bleeding is new or your bowel habit has changed.
- Could it be bowel cancer?
- Yes, that is why unexplained rectal bleeding in adults is taken seriously and may be referred on a 2-week-wait pathway. Cancer can bleed with or without pain. A change in bowel habit, unexplained weight loss, or iron-deficiency anaemia adds concern at any adult age. Early assessment is the point of the pathway, not a verdict.
- What is bowel cancer screening?
- UK nations run faecal immunochemical test (FIT) programmes that look for hidden blood. In England, people are currently invited from ages 50 to 74. You will be invited according to your UK nation's programme — ages and timing differ. A positive kit is not a cancer diagnosis; it means you need follow-up, usually a colonoscopy.
- When is rectal bleeding an emergency?
- Call 999 for heavy bleeding, collapse or fainting, severe abdominal pain, or black tarry stools if you feel very unwell. Moderate ongoing bleeding still needs same-day advice via 111 or urgent GP. Do not drive yourself if you feel faint. Ordinary small streaks on the paper with known piles still need a GP if they are new.
- I have been told I have piles — can I ignore new bleeding?
- No. Confirmed piles can coexist with other conditions. If bleeding continues despite treatment, your bowel habit changes, or you have weight loss or anaemia, go back to the GP. Do not keep buying cream and hoping. A rectal examination and, if needed, a camera test are how other causes are found.
- What will a GP do?
- They will ask about colour, amount, bowel habit, weight, family history and medicines such as blood thinners. They may examine your abdomen and back passage and arrange blood tests. Referral for a camera test is common when bleeding is unexplained. Take a list of medicines. Do not be embarrassed — this is routine work for GPs.