Lower gastrointestinal bleed (PR bleed)

History of Presenting Complaint

• Timing including onset and duration
• When exactly does it occur: only on defecation?
• Where does it occur: in the pan or on the paper (anal canal)? mixed in stool or on the surface?
• Colour of blood: bright red (lower tract) or black lumps (upper tract)
• Volume of blood
• Associated mucus? pus? pain?
• Other gastrointestinal symptoms such as diarrhoea or constipation
• Systemic symptoms: fatigue, weight loss, fever

Past Medical History

• Haemorrhoids, inflammatory bowel disease, diverticular disease, ulcers

Family History

• Bowel cancer or inflammatory bowel disease

Personal and Social History

• Smoking, alcohol, dietary intake
• Sexual history including anal intercourse

Differential Diagnosis

• Anal: haemorrhoids, anal fissure
• Colorectal: polyps, tumour, ulcerative colitis, diverticular disease, ischaemic colitis