Benign Anorectal Disease

Anal fissures can present with small amounts of fresh PR bleeding (often seen on toilet paper after wiping). They can be associated with severe pain which is worse on defecation, normally due to the passage of a hard stool tearing the anal lining. Pain results in spasm of the sphincter, often making PR examination impossible. However, if the fissure is visualised it is usually seen in the posterior mid line.

Haemorrhoids are the most common cause of rectal bleeding in those under 50 years of age [13]. Patients with haemorrhoids typically present because of one of three complications:

  1. Haemorrhage
  2. Prolapse
  3. Thrombosis

With regard to bleeding, it is usually fresh and onto the surface of the stool. It is normally self-limiting and is rarely life threatening.

Learning bite

Benign anorectal conditions normally cause minor or self-limiting bleeding.