Hematochezia in the Young Patient: A Review of Health-Seeking Behavior, Physician Attitudes, and Controversies in Management

Abstract

Hematochezia, defined as the passage of blood or clots from the rectum, is common and can be quite alarming. Few patients in general consult their physicians for this symptom. Various reasons have been explored for this behavior. Physician attitudes also shed some light onto why some patients are referred and others are not. Hematochezia may be associated with an anal cause in most healthy young adults (<50 years of age), but some may end up being diagnosed with colorectal cancer (CRC). Many studies have looked at the usefulness of clinical presentation in helping to decide which patients need further evaluation and what the optimal mode of investigation should be. Of note, studies on patients less than 50 years of age presenting with rectal bleeding have been few and far between. The results of these studies have been contradictory to the point where, today, there is no single set of consensus guidelines on the approach to hematochezia in young patients. In this review, the value of clinical symptoms and the underlying risk of CRC in guiding this clinical decision will be discussed.

Rectal bleeding and prolapse� not always benign diseases rather anal cancer. The importance of a correct decision making since primary care

“…Since in patients <40 years-old there is a 2-9% of CCR, in these patients with a rectal bleeding without other symptoms a sigmoidoscopy should be recommended (3,10). Of course, the most possible diagnoses are anal diseases like hemorrhoids and fissures that account to 34% and inflammatory disease (8%).…”

“…The number of patients that recur to primary care for rectal bleeding is 4-6/1000 inhabitants (1). Nevertheless around the 30% of the patients never consult a physician for this problem (3). Primary care physicians have to stratify patients basing on urgency and on the colo-rectal cancer risk and to conduct a decision making for the correct management (2).…”

Predictors of time to hospital among people with colorectal cancer

“…In general, the common symptoms were general or localized abdominal pain, rectal bleeding, change in bowel habits, which were broadly termed as diarrhea or constipation, change in frequency of defecation, the shape of stool (e.g., more narrow than usual, mucous bloody stool, difficulty in evacuation or tenesmus) (ACS, 2020; Courtney et al, 2012b;John et al, 2011;Labianca et al, 2013). Including weight loss without specific causes, bloating, iron deficiency and anemia, weakness, fatigue, fever, night sweats, and sometimes short breath (ACS, 2017(ACS, , 2020John, et al,2011;Khan & Hyman, 2010;Labianca et al, 2013). Also, CRC-related symptoms were associated with a chronic functional condition such as irritable bowel syndrome, chronic constipation, benign anorectal lesions, severe abdominal pain, and abdominal mass (Vega et al, 2015).…”