Indication for colonoscopy or Barium Enema

Indications for colonoscopy or Barium enema, in patients with blood per rectum and haemorrhoids;

• Always
• Bleeding is not the typical bright red post defecation
• Associated change in bowel habit
• Age over 50
• Bleeding has not ceased after treatment of haemorrhoids

The main other cause of bleeding in patients less than 50 is proctitis and in those older than 50 cancer.

It is not practicle to do a full colonoscopy on everyone who presents with bleeding PR.