Surgery | Common Surgical Conditions | General Surgery Rectal Bleeding

General Surgery: Rectal Bleeding
Session Overview
Description
This session outlines the aetiology, investigation, and management of common and serious conditions causing bleeding originating from the rectum and anus. It also revises the 2 week-wait referral guidelines for suspected lower GI cancer.

Learning Objectives
By the end of this session you will be able to:

• List the common and serious causes of bleeding from the rectum and anus
• Describe how to investigate rectal bleeding appropriately depending on the context
• Recognise the 2 week wait referral guidelines for suspected lower GI cancer
• Formulate an appropriate management plan for rectal bleeding, in the non-emergency setting

Rectal bleeding, defined as bleeding originating from the rectum or anus, is a common presenting symptom in both primary and secondary care. Although the majority of cases are attributable to benign anal conditions including haemorrhoids and anal fissure, serious causes must always be considered and excluded.

Its assessment includes a detailed history together with an inspection and digital rectal examination of the anorectum +/-proctosigmoidoscopy, which is often enough to reach a diagnosis in younger patients.

Red flags including associated features should prompt further investigation. Rectal bleeding is included in the 2 week wait referral criteria for suspected cancer in older patients. It is particularly concerning if it is of new onset in a patient over 60, or when associated with an alteration in bowel habit in one over 40.

The treatment of rectal bleeding depends on the underlying cause and the management of the commonest conditions is covered later in this module.