How should I manage a patient with anal cancer who presents with pain and bleeding?

When a patient with anal cancer presents with pain and bleeding, it is important to recognise these as potential side effects or complications of their cancer treatment ¹. Patients who have undergone surgery for colorectal cancer, which can include procedures affecting the anal region, should be informed about possible physical changes such as anal discharge or bleeding ¹. Pain is also a known short-term, long-term, permanent, or late side effect of treatments for colorectal cancer ¹.

Patients should be advised on how, when, and where to seek help if these side effects become problematic ¹. If the pain or bleeding is related to bowel dysfunction, primary care can offer initial treatments such as dietary management, laxatives, anti-bulking agents, anti-diarrhoeal agents, or anti-spasmodic agents ¹. However, if these treatments are not successful, advice should be sought from secondary care ¹.