Differential diagnosis
Common
- Haemorrhoids (uncomplicated)
Infrequent
- Anal fissure
- Colorectal cancer
- Colonic diverticular bleeding
- Ischaemic colitis
- Campylobacter infection
- Meckel's diverticulum
- Thrombosed haemorrhoids
- Ulcerative colitis
- Acute mesenteric ischaemia
- Shigellosis
Rare
- Intussusception
- Anal cancer
- Crohn's disease
- Henoch-Schonlein purpura
- Cow's milk protein intolerance/allergy
- Haemolytic uraemic syndrome
Specific differential diagnosis
Further management
NICE cancer referral guidelines for colorectal cancer suggest the following:
Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults with a rectal or abdominal mass.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:
- they are aged 40 and over with unexplained weight loss and abdominal pain or
- they are aged 50 and over with unexplained rectal bleeding or
- they are aged 60 and over with:
- iron‑deficiency anaemia or
- changes in their bowel habit, or
- tests show occult blood in their faeces.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults with a rectal or abdominal mass.
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:
- abdominal pain
- change in bowel habit
- weight loss
- iron‑deficiency anaemia.