Approach to evaluation of an adult patient with suspected hemorrhoidal bleeding

GI: gastrointestinal.

* Hemorrhoidal bleeding is almost always painless and is usually associated with a bowel movement, although it can be spontaneous. The blood is typically bright red and coats the stool at the end of defecation or may drip into the toilet. Occasionally, bleeding can be copious and can be exacerbated by straining.

¶ Refer to related UpToDate topics on hemorrhoids.

Δ Patients with melena, dark red blood per rectum, or postural vital sign abnormalities should undergo an upper endoscopy in addition to a colonoscopy.