How serious is blood after a bowel movement?

A fellow caregiver asked...

I have fought with constipation my whole life and will have blood on the toilet paper after a hard movement. Last week, I had blood and some clots on the paper but my movement wasn't that hard. It lasted one day and then I had nothing until five days later...the same thing happened. It is only on the toilet paper when I wipe, not on my underwear. I do have a doctor appointment but am very concerned. How much blood is too much blood? Does it matter how or how much of it is present? Thank you

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

I am happy to hear that you scheduled an appointment with your doctor.  Blood after a bowel movement is never "normal"- it is a sign that something is going on.  Any bleeding from the rectal area should be checked out by a health care professional. 

While the small amount of blood on the toilet paper after hard BMs probably is from  hemorrhoids, the clots you describe are more concerning.  Your doctor will probably refer you to a Gastroenterologist to see what is going on with your chronic constipation and bleeding.  You will probably need a colonoscopy to see what is happening inside your rectum and colon, so they can figure out  where you are bleeding. 

I know that you are concerned, but you are doing the right thing by getting it checked out.  I am sure the thought of cancer has crossed your mind, as it is a possibility.  But, your bleeding may be from hemorrhoids, polyps, or diverticulosis as well.  Hope all goes well, and good luck.