PR Bleeding and/or Haemorrhoids

This condition is treated in the Colorectal surgery clinic.

Pre-referral work-up

History

• Refer for colonoscopy if underlying disease is suspected
• All referrals should comply to the referral standards. and include:
  • An associated change in bowel habit
  • Blood mixed with stool
  • Palpable mass on rectal examination
  • Associated pain and discomfort in the absence of thrombosis or other pathology such as a fissure
  • Copious bleeding with associated anaemia
  • Note if there is any high risk family history
  • Pathology results, Essential: FBE and if anaemic please provide iron studies & B12
  • BMI (or height & weight) and use of anticoagulants or iron supplements
  • If possible please complete the PR Bleeding Patient Questionnaire and fax with your referral. This questionnaire can be downloaded as a PR Bleeding Patient Questionnaire - PDF version or using the PHT referral template which you can download into your practice software.

Tests

• PR examination and results
• Check for prolapse and thrombosis of haemorrhoids
• Include if any, level of suspicion of underlying malignancy

Interim/GP management

To refer a patient with this condition, please see the Colorectal Surgery clinic page for the full referral process and templates.

Symptom management advice should be offered for patients without suspicious symptoms such advice might be a high fibre diet for internal haemorrhoids, and a glyceryl trinitrate-based ointment for an anal fissure.

Review patients if symptoms change.

Related information found in the Gastroenterology and General Surgery guidelines.

For more information please see the HealthPathways Tasmania website.

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Urgent (Category 1)

? Blood mixed in with stool

? Anaemia

? Pain

? Weight loss

? Abdominal Mass

? Iron deficiency anaemia +/- positive FOBT

For urgent referrals call the RHH switch on 6166 8308 and ask for the nurse in charge of surgical clinics or the relevant consultant to expedite the consultation.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.

Semi-urgent (Category 2)

Change in bowel habit (To looser stools and/or increased frequency of defecation persistent for 6 weeks)

High risk family history (1st degree relative under 50 years of age at onset of colorectal cancer OR more than one 1st degree relative with colorectal cancer)

Where there has been a recent benign colonoscopy and unexplained or recurrent rectal bleeding

Positive FOBT

Routine (Category 3)

under 40 years of age with chronic haemorrhoidal type bleeding (no change in pattern)

Next available appointment

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

North West Regional Hospital
Phone: 03 6493 6300
Fax: 03 6464 1928

South

Liverpool Clinics (Level 7)
Phone: 03 6166 0000
Fax: 03 6234 9941