Colonoscopy for Intermittent Rectal Bleeding: Impact on Patient Management

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Rectal bleeding is a frequent presenting symptom of a number of benign anorectal disorders. However, it may also be a warning sign of more significant gastrointestinal pathology. For this reason, full colonic evaluation has been recommended in patients with intermittent bright red rectal bleeding. The purpose of this study is to evaluate the utility of colonoscopy in this setting. Data were prospectively collected on 125 colonoscopies performed on the surgical service at the Cleveland Wade Park Veterans Administration Medical Center during a two year period. During this period 33 patients underwent colonoscopy for the evaluation of intermittent bright red rectal bleeding. Fourteen patients had abnormal rectal exams, including hemorrhoids in 9, mass lesions in 3, prolapse in 1, and fistula in ano in 1. Colonoscopy was normal in only 7 (21%) of the 33 patients examined. Findings in the remaining 26 included 31 polyps in 14 patients, cancer in 3, AVM in 1, diverticula in 9, hemorrhoids in 4, and other benign lesions in 5. Positive findings on rectal examination had no relationship to findings at endoscopy, with abnormal findings in 52% of patients with normal rectal exams and in 27% of patients with abnormal rectal exams ( P ≈ 0.187, NS). Findings at colonoscopy resulted in a change in management in 16 (48%) of patients examined. In patients with intermittent rectal bleeding, the entire colon should be evaluated regardless of findings on rectal examination, as a significant number of patients will have concomitant findings. Colonoscopy is an excellent method for colonic evaluation in this setting. Endoscopy is a sensitive method for detection of those lesions likely to cause bleeding and may also provide a means of treatment. Furthermore, findings at colonoscopy can be expected to result in a change in management in a significant number of patients.