How should I counsel patients regarding the potential causes and implications of haematochezia?

Counsel patients on the potential causes of haematochezia by explaining that it refers to the passage of fresh blood per rectum, which can arise from various sources in the lower gastrointestinal tract, such as haemorrhoids, anal fissures, diverticular disease, inflammatory bowel disease, or colorectal cancer.

Emphasise the importance of assessing associated symptoms such as changes in bowel habits, weight loss, abdominal pain, or a palpable rectal mass, as these may indicate more serious underlying conditions including malignancy, warranting urgent investigation and referral.

Advise patients to seek prompt medical evaluation if haematochezia is accompanied by systemic symptoms like dizziness, fainting, or signs of significant blood loss, as this may indicate major bleeding requiring urgent care.

Inform patients about the diagnostic process, which may include physical examination (including rectal examination), stool tests, and potentially endoscopic investigations to identify the bleeding source and exclude cancer, especially in patients over 55 or with risk factors.

Discuss the implications of haematochezia by reassuring that many causes are benign but also highlighting the need for timely assessment to exclude serious pathology and to guide appropriate treatment.