lumps, urgency, tenesmus – more likely a rectal cause
Change of bowel habit – suspect cancer of rectum or left colon
R colon cancer more likely occult – anaemia
Examination
Anal inspect
DRE
Proctosigmoidoscopy
If there is a benign lesion and patient <40- manage – arrange review at 6 – 8 weeks – must consider to exclude a proximal lesion with sigmoidoscopy. Do a colonoscopy if there are any bowel symptoms or if the patient is > 40
Type of bleeding
If bright red blood after a bowel motion or on paper – consider outlet pattern suggestive of a lesion near or in the anal canal – e.g. Haemorrhoids, fissure
Blood is coating or mixed with the stool – consider source high in colon e.g. Polyps, IBD, cancer
Melena – consider upper GI or proximal colon bleeding – e.g. Peptic ulcer, esophageal varices, upper GI malignancy