Anorectal Symptom
Rectal bleeding is alarming. It is also extremely common — and in the vast majority of cases, the cause is benign: hemorrhoids, anal fissures, or another treatable condition. Most patients with rectal bleeding are not facing cancer.
That said, rectal bleeding is also the most important early warning sign of colorectal cancer. It deserves evaluation. Not panic — evaluation. We are going to be direct about what to look for, when to be seen, and what we'll do once you are here.
Most patients tell us they assumed the symptom was minor — or just something they would have to live with. Neither is usually true.
The most common pattern. Usually originates very close to the anal opening — most often an internal hemorrhoid or an anal fissure. Almost always benign, almost always treatable.
Originates from slightly higher in the rectum. Usually still hemorrhoidal in origin but warrants a careful evaluation to be certain.
Originates higher in the colon. Warrants prompt evaluation and usually colonoscopy. Not within PHII's primary scope — we will coordinate the referral if it is what you need.
Suggests bleeding from the upper GI tract. Requires urgent evaluation, often in an emergency setting. This is not something to manage with an outpatient appointment.
Treatment Approach
Most patients with rectal bleeding improve significantly with behavioral, physical, and minimally invasive treatments — long before surgery enters the conversation. Here is the full toolbox, in the order we typically work through it.
What to Expect
A comprehensive first evaluation with Dr. Johnson. Time to be listened to. In-office diagnostics when possible.
Dr. Johnson has read your intake before you walk in. The conversation starts with the impact on your life — not the textbook.
Performed with explanation at every step. Nothing happens without your full awareness and consent.
Diagnostics are performed in-office where possible to avoid extra appointments.
Every option explained. Pros, cons, and what each one would mean for your week, your work, and your life.
A Patient Story
I was terrified. I had been bleeding for six weeks and assumed the worst. Dr. Johnson saw me within four days, diagnosed an internal hemorrhoid in the first ten minutes, and explained the screening timeline I should be on regardless. The relief was indescribable.
— G.O., evaluated for new-onset rectal bleeding
Frequently Asked
Almost never the worst-case scenario, but always worth evaluating. The two most common causes — internal hemorrhoids and anal fissures — are entirely benign and entirely treatable. The reason we still want to see you is that the rare causes that aren't benign are far more treatable when caught early.
— Lisa L. Johnson, M.D., U.R.P.S.
Heavy bleeding, lightheadedness, black or tarry stools, or a change in bowel habits accompanying the bleeding warrant prompt — often emergency — evaluation. Persistent bleeding for more than a few days, even if mild, also warrants an appointment within the next week or two.
— Lisa L. Johnson, M.D., U.R.P.S.
Depends on the pattern of bleeding, your age, your family history, and whether you are due for routine screening. Many patients with classic hemorrhoidal bleeding do not need a colonoscopy specifically for that bleeding — but they should still be up to date on routine colorectal cancer screening. We will tell you honestly which category you are in.
— Lisa L. Johnson, M.D., U.R.P.S.
It is the question on every patient's mind, so I want to answer it straight. In most patients — particularly under 45, particularly with classic bright-red, painless or activity-related bleeding — the answer is overwhelmingly likely to be no. For older patients, patients with risk factors, or patients with concerning bleeding patterns, we evaluate carefully and coordinate the right next step. We will not minimize, and we will not catastrophize.
— Lisa L. Johnson, M.D., U.R.P.S.
Blood thinners amplify bleeding from any source — including hemorrhoids that might otherwise be silent. We still want to see you, we still want to identify the source, and we will coordinate with your prescribing physician about any medication considerations around treatment.
— Lisa L. Johnson, M.D., U.R.P.S.
A thorough, unhurried evaluation with Dr. Johnson. You will leave with a written plan — and clarity on what rectal bleeding is doing in your body, and what to do about it.
