Red Blood on Toilet Paper (Non-Menstrual): Causes and Evaluation

Common Anorectal Causes

• Hemorrhoids: Bright red blood on paper/in bowl; painless (internal) or painful (thrombosed external).
• Anal fissure: Sharp pain with BM + bright streaks on paper; sentinel tag.
• Constipation/straining: Mechanical trauma to mucosa.

Urogenital Causes

• UTI: Hematuria (pink/red urine), dysuria, frequency.
• STIs: Chlamydia, gonorrhea, herpes – urethral/cervical bleeding.
• Ectopic pregnancy: Vaginal bleeding + abdominal pain; emergency.

Other Considerations

• Colorectal polyps/cancer (age >45, risk factors) – occult or visible blood.
• Inflammatory bowel disease (Crohn's, ulcerative colitis).
• Medication effect (anticoagulants, NSAIDs).

When to See a Doctor

• Bleeding >1 week, recurrent, or >scant spotting.
• Associated pain, weight loss, change in bowel habits.
• Age ≥45 (screening colonoscopy indicated).
• Any suspicion of ectopic pregnancy.

Anoscopy, colonoscopy, or urinalysis/STI testing directs diagnosis.