The cause of this important symptom should always be determined. Though frequently due to haemorrhoids or an anal fissure, these are so commonplace that their presence in a patient with rectal bleeding should not lead to the assumption of cause and effect. The differential diagnosis includes colorectal carcinoma, ulcerative colitis, infective colitis and complicated diverticular disease (Table 5.17). Bleeding from the anal canal is bright red; it is usually clearly separate from the faeces and often seen only on the toilet paper. 1 laemorrhoidal bleeding may be profuse and splash the toilet bowl and/or continue following defecation. Bleeding from an anal fissure is usually associated wilh anal pain which occurs during and after defecation. Colitis is commonly associated with the symptoms of urgency of defecation and the passage of unformed stools wilh blood, mucus and pus. Both colonic adenomas and carcinomas may cause excessive mucus production. Bleeding from any site along the gastrointestinal tract may also present wilh syncopc, peripheral circulatory failure or the symptoms of chronic anaemia.
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