Hi there, Thanks for your query. With a low INR (you have not mentioned the reading), the possible causes are either bleeding piles or abrasions in the anal wall; remote possibility of a silent mild bleeding in stomach/intestine. Consult your doctor who will directly visualize the anal canal from inside with help of a Proctoscope and, possibly, endoscopy if he feels that there may be concealed bleeding inside the stomach. Depending on the findings, he will prescribe appropriate treatment. If you find my response helpful and informative, do not forget an “excellent” (5-star rating) to my answer, to ENCOURAGE all doctors- engaged in social service- to render sound advice to the FREE queries. Fond regards and have a nice day Dr. Rakesh Karanwal