What management strategies are recommended for patients with mild to moderate rectal bleeding without alarming features?

Management strategies for patients presenting with mild to moderate rectal bleeding without alarming features include:

• Conduct a thorough clinical assessment to exclude alarming features such as significant anaemia, weight loss, or changes in bowel habits suggestive of malignancy or serious pathology.

• For suspected diverticular disease, which can present with mild rectal bleeding, reassure patients that diverticulosis is often asymptomatic and does not require specific treatment.

• Advise patients to maintain a healthy, balanced diet rich in whole grains, fruits, and vegetables, and to increase fibre intake gradually if constipation is present, ensuring adequate fluid intake to reduce symptoms and potentially prevent further bleeding.

• Consider the use of bulk-forming laxatives if constipation is contributing to symptoms.

• Do not routinely refer patients for endoscopic or radiological investigations unless there are persistent symptoms, suspicion of colitis, or criteria for suspected cancer pathway are met.

• Provide safety-netting advice, including monitoring for any new or worsening symptoms such as increased bleeding, pain, or systemic symptoms, which would warrant urgent reassessment.

These strategies focus on conservative management and watchful waiting in the absence of red flags, aiming to avoid unnecessary invasive investigations while ensuring patient safety.

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