Hematochezia and Melena

Rectal bleeding is an alarming symptom; it is definitely abnormal, and although the most common causes are benign, there is always the possibility of a more severe illness. Investigation of rectal bleeding has several aims: (1) to exclude a neoplasm, (2) to find the cause of the bleeding and (3) to stop the bleeding by the least invasive means possible. Patients are triaged on the basis of risk factors and are offered different approaches to the problem according to the results of the triage. Hematochezia means passage of blood in the stools. Chronic rectal bleeding can manifest as melena, hematochezia, as well as those situations where blood is passed separately from stool, such as in the case of purely anorectal causes of bleeding. In this chapter, we have provided algorithms, figures, tables and illustrations to guide the clinician in the evaluation and treatment of this complex problem.