Rectal bleeding

Data gathering

• Red flags – weight loss, change in bowel habit, abdo pain, fevers
• Others – pain on defaecation, itching, constipation
• Examine – abdominal exam, PR exam

Clinical management

• Investigations
  • Bloods – FBC, U+Es, LFTs, Ferritin, ESR, CRP, clotting
  • Stool – MC&S

• Explanation
  • a small tube with a tiny camera is inserted into the back passage to investigate the cause of the bleeding
• Treatment
  • Depends on cause
    • Fissure – dietary and fluid advice, GTN ointment and stool softeners for 8 weeks
    • Haemorrhoids – dietary and fluid advice, OTC haemorrhoid creams

• Follow-up / Safety-net
  • Refer
    • failed conservative treatemnt for fissure/haemorrhoids after 6 weeks
  • 2 week wait
    • 40yo + weight loss + abdo pain
    • 50yo + PR bleed
    • 60yo + iron def anaemia or bowel habit changes