Complacency or ignorance about rectal bleeding?

The aim is to assess the importance that patients attach to their symptoms of rectal bleeding and their perception of its possible causes.

Patients referred by their general practitioner (GP) to the Surgical Out-patients Clinic with a history of rectal bleeding were asked to fill in a questionnaire about the symptoms and their perceptions of the complaint. Data on 104 (61 female, 43 male) consecutive patients between the ages of 17 and 88 years are presented.

Fifty-eight (55.8%) patients had experienced rectal bleeding on at least one previous and unrelated occasion, many (n=32) patients experienced it multiple times. However, only two-thirds (n=36) of patients immediately sought advice. Embarrassment, non-importance or 'that the bleeding stopped too quickly' were the most cited reasons for delay. Increasing personal concern (66.3%), the development of accompanying symptoms (16.3%), persistent bleeding (9.6%), or the bleeding becoming a nuisance (3.8%), prompted medical advice. Seventy-five percent of patients were immediately referred on by their GP. Only 46 (44.2%) patients associated rectal bleeding with cancer of the large bowel. Haemorrhoids (piles) was most frequently acknowledged (92 patients or 88.5%). Anal fissure, polyps, colitis, and diverticulosis were also recognized causes.

Improved health information relating to colorectal cancer, perhaps in a more direct symptom format reflecting the importance of rectal bleeding, is necessary to reduce patient complacency.