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Gastroenterology
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Minimal Bright Red Blood Per Rectum
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Age + red flags decide anoscopy vs colonoscopy.
Decision
Outcome
Decision
Minimal BRBPR — age/red flags?
✓
<40 without red flags → anoscopy
✓
40–49 without red flags → anoscopy, then sigmoidoscopy/colonoscopy if no source
✓
≥50 OR red flags (weight loss, change in bowel habits, anemia, FH colon ca) → colonoscopy
Decision
Anoscopy result?
✓
Hemorrhoids identified → no further evaluation needed
✓
No source found → sigmoidoscopy or colonoscopy
Outcome
Sitz baths, fiber, topical care; banding if persistent
Outcome
Colonoscopy — identify and treat source