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In young and middle-aged persons, bleeding from the anus is most commonly caused by haemorrhoids (piles) or an ulcer in the anal area. Ulcers usually result from mechanical damage. In a person with constipation, the stool mass is hard and stretches the anus, which results in cracks in the thin anal mucosa. 

Haemorrhoids are enlarged veins in the anal area. They are basically the same phenomenon as varicose veins in the legs. Factors contributing to haemorrhoids include constipation and sedentary work. To prevent haemorrhoids, make sure you consume enough fibre and enough fluids and get enough exercise in your everyday activities. Women often develop haemorrhoids during pregnancy.

Symptoms

The ulcers may cause bleeding, which is usually noticed after passing stools. Haemorrhoids may also cause heavier bleeding. The blood is bright red. Haemorrhoids and anal ulcers may also cause pain and itching. 

Self-care

In terms of self-care, it is important to make sure the anus is clean. The recommendation is to shower the anus a couple of times daily and always after a bowel movement. Good hygiene also includes drying, which should be done without rubbing the area. To alleviate pain, use prescription-free creams and suppositories available from a pharmacy. Using an NSAID (non-steroidal anti-inflammatory drug) for a few days may also reduce pain. To prevent the recurrence of haemorrhoids, make sure you have regular bowel movements and avoid constipation.

When should I seek treatment?

You should contact a health care professional if the symptoms continue for more than two weeks in spite of self-care, or if a haemorrhoid is very painful. If you have bleeding from the anus associated with diarrhoea and uniformly bloody stools, this may be caused by large bowel inflammation (colitis) that should be examined and treated by your doctor. 

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner / 9 September 2019