How should I approach the initial investigation of a patient with suspected proctitis in primary care?

Initial investigations for suspected proctitis in primary care should begin with a thorough clinical history and examination focused on symptoms such as rectal pain, bleeding, discharge, and changes in bowel habits. A general and anorectal examination should be performed to identify signs of inflammation, infection, or other pathology.

Consider baseline blood tests including inflammatory markers to help exclude inflammatory bowel disease or infection. Stool samples may be taken to test for infectious causes, including sexually transmitted infections if relevant.

Red flag symptoms such as severe pain, systemic illness, or suspicion of malignancy warrant urgent referral to secondary care for further investigation. Endoscopic evaluation and biopsy are typically required for definitive diagnosis but are usually arranged by secondary care.

In primary care, initial management should also consider other causes of symptoms such as irritable bowel syndrome or diverticular disease, and exclude these through history, examination, and appropriate investigations.

Referral to specialist services is indicated if symptoms persist, worsen, or if there are concerns about cancer or inflammatory bowel disease.

This approach ensures safe, timely assessment and appropriate onward referral while managing patient expectations and involvement in decision-making.

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