A great number of patients are frequently referred for specialist advice because they have experienced rectal bleeding. The bright rectal bleeding usually does not come from anywhere more proximal than the splenic flexure. Complete evaluation should include a flexible sigmoidoscopy. During evaluation many patients are found to have Internal Haemorrhoids that could well be the source of bleeding. There is always a dilemma: whether or not to reassure the patients that the bleeding is caused by nothing more serious than simple haemorrhoids or whether to consider that the reference of the diagnosis included an obligation to treat. I have pursued a policy of treating all patients referred for assessment of the cause of bleeding when the only source of bleeding seems to be piles. They have the base of their internal haemorrhoids coagulated with the photocoagulator. Of 250 patients attended at the Clinic of Proctology of Maranhão because of rectal bleeding, 200 were treated with minimal morbidity and needed just one treatment stage. It is proposed that photocoagulation is such a simple trouble-free form of treatment that it can safely be applied at the end of any evaluation for bright red rectal bleeding and that such policy enables the majority of those referred patients to be managed in a single visit.
Anal bleeding; Haemorrhoids; Photo Coagulation