Rectal bleeding in general and hospital practice; ‘the tip of the iceberg’

Abstract

Many people in the community have painless rectal bleeding, an associated change in bowel habit and dark red bleeding, factors previously thought to indicate a high risk of colorectal cancer. Rectal bleeding has however a low (1:709) predictive value for cancer. As the result of a considerable selection process, only a small number are investigated in hospital. These patients therefore represent a small proportion of all patients with this symptom. The value of the factors used to decide which patients need investigation should be re-assessed.