Rectal bleeding in patients less than 50 years of age

The study group consisted of 102 patients that presented for evaluation of rectal bleeding. All patients were 50 years of age or less and were evaluated with a flexible endoscope and an anoscope. The findings from each examination were recorded independently. Sigmoidoscopy and anoscopy were performed in 56 patients less than age 40 (group I), and colonoscopy and anoscopy were performed on 46 patients between the ages of 40 but less than 50 years (group II). Anoscopy was superior to flexible endoscopy in detecting hemorrhoids in group I (P < 0.001 and group II (P < 0.004). The guaiac status of patients was not influenced by the presence of hemorrhoids. Three patients in group I and eight patients in group II had polyps. The likelihood of finding a polyp was not influenced by the guaiac status of the patients. Three patients in group I and one patient in group II had anal fissures that were missed with flexible endoscopy and detected with anoscopy. Five of 102 patients were noted to have diverticula; all of these were in group II. However, this was not felt to be the source of the bleed given the clinical history. Overall, six patients had colitis; all but one of these patients were less than 40 years of age. Flexible endoscopy and anoscopy provide complimentary information in middle-aged adults with rectal bleeding.