Examining a patient with rectal bleeding

Rectal bleeding is defined as fresh or clotted blood in the faeces or in association with defecation. The colour of the faeces may be otherwise normal, in contrast to melena , which is defined as black, tar-like stools or the maroon stool often seen with caecal bleeding.The site and cause of the bleeding must be identified, most importantly separating bleeding from the anal canal versus the proximal colon. The former can often be handled locally, whereas the latter requires a more global approach.Patients in whome the bleeding is caused by a tumour, inflammatory bowel disease or other severe condition requiring specific treatment must be identified, examined and treated.In patients with haemorrhoids, anal fissure, excoriation of anal skin or other mild condition the treatment is symptomatic.