Loss of blood from the back passage or anus is a very common symptom in adults of all ages and in most people is usually intermittent and often self-limiting. Most patients present because of anxiety about serious underlying pathology, and following reassurance are content to live with minor symptoms.
This pathway has been published to clarify best practice in primary care for ano-rectal bleeding.
Please click the relevant flowchart box to be taken directly to textual information
Ano-rectal bleeding is the passing of bright red blood from the back passage or anus.
It is very common and has an annual prevalence of about 10% in the UK. It has a positive predictive value (PPV) for colorectal malignancy of 8% in patients aged over 50 years presenting to primary care. Most perianal causes will be improved with application of topical treatment, increased high fibre diet and/or oral fibre supplement with increased oral fluid intake.
Best practice in primary care includes careful attention to the history, including:
Any patient with rectal bleeding who meets the following criteria should be referred urgently under the two week wait guidelines for suspected colorectal cancer as recommended by NICE Referral Guidelines for Suspected Cancer (NICE NG12):
Aged 50 years or over with unexplained rectal bleeding or
Aged under 50 years with rectal bleeding and any of the following unexplained symptoms or findings:
change in bowel habit
Patients referred on the two week wait pathway usually require investigation, including FBC, U&E and LFT.
The above pathway aims to provide the necessary guidance required to support the management of your patient, however if you would like to discuss a specific patient's case further please seek Advice & Guidance, via the NHS e-Referral Service, from GHNHSFT's Consultant Gastroenterologists as an alternative to making a referral. Advice & Guidance can be helpful in the following circumstances:
Please view the resource for further information on using the Advice & Guidance service.
Ongoing care will vary as appropriate according to the cause of the rectal bleeding and the response observed to treatment.
After any treatment for haemorrhoids or fissures, patients should be advised to remain on a high fibre diet with good oral fluid intake to prevent recurrence. Patients with new or recurring symptoms should be reassessed.