Anorectal bleeding: Etiology, evaluation, and management (with videos)

Anorectal bleeding is frequently encountered in clinical practice. Evaluation of patients presenting with anorectal bleeding requires a thorough history and physical examination, including anorectal examination. An understanding of the anorectal anatomy with particular attention to the vascular supply is essential. Patients with anorectal bleeding with symptoms suggestive of proximal disease and/or older patients require a complete colonoscopy. In other patients, a flexible sigmoidoscopy appears to be more cost-effective. There is a paucity of scientific literature on a number of anorectal disorders that can result in bleeding, which is reflected in the lack of consensus statements and guidelines for management. Epidemiologic studies are required to define incidence and prevalence of several etiologies for anorectal bleeding before studies looking at optimal management can be undertaken.