Rectal Bleeding in adults : Triage

Rectal bleeding in adults is a common symptom that can range from mild to severe, affecting approximately 10% of adults in the UK annually. It's a concerning symptom for many, leading one in five primary care patients to report such incidents within a year. Often, rectal bleeding is intermittent and self-limiting, prompting only a minority to seek medical attention. Those who do typically are motivated either by significant discomfort or worry about serious underlying conditions.

Despite the potential for alarm, most cases encountered in primary care are attributable to benign anorectal disorders, like haemorrhoids or anal fissures. Yet, the differential diagnosis is broad, encompassing not only colorectal cancer and inflammatory bowel diseases, such as ulcerative colitis but also specific rectal conditions like proctitis and anorectal malignancies. Rectal bleeding can indicate pathology along the entire lower gastrointestinal tract, underscoring the need for a careful and comprehensive evaluation to exclude particularly sinister causes.

Given the variability in aetiology, less than half of those experiencing rectal bleeding will consult a healthcare provider. When they do, the responsibility falls on the healthcare professional to thoroughly assess and identify the bleeding source. This includes considering multiple concurrent causes and prioritizing the exclusion of colorectal malignancy...