Investigation of rectal bleeding.

We studied a consecutive series of 115 patients presenting to one gastroenterologist with non-emergency rectal bleeding or positive faecal occult blood studies. When there is a clear history that the bleeding was perianal, 26 out of 33 patients (79%) were found to have haemorrhoids. In the absence of such a history (n = 82), 16 patients (20%) had colonic cancer or polyps, 20 (25%) colitis; 24 (29%) perianal disease while only 15 (18%) had no pathology demonstrated. Our experience coupled with a review of the literature on the investigation of rectal bleeding lead us to the following recommendations: (1) Total colonoscopy or flexible sigmoidoscopy plus double contrast barium enema should normally be performed; (2) when there is a clear history that the bleeding is perianal, flexible sigmoidoscopy may suffice.