Straight out of the list of ‘Embarrassing things to see your GP about’, this is a presentation that patients love to hate. From a GP perspective, it’s one that is generally straightforward to deal with, and effective treatment can usually be offered immediately, much to the patient’s relief.
Because of embarrassment on the part of the patient, this may well present as a ‘while I’m here’ symptom. The temptation to make a diagnosis without examination should be resisted – some of the causes (such as perianal abscesses) require urgent attention and others may, rarely, provide something of a surprise (e.g. fistulae, carcinoma).
This is usually severe and distressing. Because of reflex sphincteric spasm, constipation very often follows and increases the pain and suffering further. Adequate examination is also difficult for the same reason; fortunately if a PR exam is too difficult, a visual inspection can often yield the diagnosis.
This is a very common presenting complaint and creates a lot of anxiety in the patient. By far the likeliest causes are haemorrhoids or a fissure, but more sinister pathologies should be considered according to the clinical picture, especially in older patients.
Bleeding from anywhere tends to generate a great deal of anxiety. If that bleeding is from the rectum, and the patient is a child, then the stress levels inevitably multiply. So while this is a relatively unusual presentation, it will often present as an ‘urgent’ and typically require much reassurance. GPs have to deal with their own anxiety too – of overlooking the rare serious cause