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Rectal bleeding. Do other symptoms aid in diagnosis?
A Mant1, E L Bokey, P H Chapuis
1Royal Australian College of General Practitioners, Colorectal Unit, Concord Hospital, N.S.W., Australia.
Diseases of the Colon and Rectum
|March 1, 1989
Summary
Predicting the source of rectal bleeding is challenging for general practitioners. Blood mixed with feces slightly increases colorectal cancer probability, but most symptoms are unhelpful for diagnosis in patients over 40.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- General Practice
Background:
- Distinguishing between anal and colorectal bleeding sources is difficult for primary care physicians.
- Rectal bleeding is a common complaint requiring accurate diagnostic evaluation.
- Early detection of colorectal cancer and polyps is crucial for patient outcomes.
Purpose of the Study:
- To identify historical or clinical features that strongly indicate colorectal cancer or polyps in patients with rectal bleeding.
- To assess the diagnostic utility of various symptoms and clinical signs in patients referred for colonic investigation.
- To improve the decision-making process for referring patients with rectal bleeding for further colorectal assessment.
Main Methods:
- A prospective study of 145 consecutive patients aged 40 and older presenting with rectal bleeding.
- Patients were referred by general practitioners for comprehensive colonic investigation.
- Fifteen distinct symptoms and clinical features were systematically examined for their association with bleeding source.
Main Results:
- Few of the examined symptoms and clinical features showed a statistically significant association with the bleeding source.
- Patients reporting blood mixed with feces had a 21% probability of colorectal cancer.
- Most bowel symptoms and clinical features were not effective predictors for colorectal pathology.
Conclusions:
- Clinical history and physical examination alone are often insufficient to reliably determine the source of rectal bleeding.
- The presence of blood mixed with feces warrants consideration for colorectal cancer, but is not definitive.
- Further colorectal assessment remains essential for patients aged 40 and older with recent-onset rectal bleeding, regardless of initial clinical findings.