Rectal passage of minimal bright red blood most commonly occurs in a chronic intermittent pattern and has also been referred to as "intermittent scant hematochezia" . Although we are unaware of any standardized definition, in this review we use the term minimal bright red bleeding per rectum (BRBPR) to indicate such patient complaints as small amounts of red blood on toilet paper after wiping or a few drops of blood in the toilet bowl after defecation. Small amounts of blood on the surface of the stool is also considered minimal BRBPR, but red blood intermixed with stool is not.
Benign etiologies are common, and there are few recommendations on the appropriate evaluation of patients with minimal BRBPR. This topic reviews the evidence for evaluating such patients and makes recommendations for evaluation based on age and other risk factors for more serious etiologies of minimal BRBPR. The approach to patients who pass larger amounts of blood or blood intermixed with stool is discussed elsewhere. (See "Approach to acute lower gastrointestinal bleeding in adults".)
SCOPE OF THE PROBLEM
By self-report, minimal BRBPR occurs in approximately 15 percent of people [2-4]. The problem may be even more common in younger adults because of under-reporting to physicians [2,4,5]. This latter point was illustrated by the following:
●A study of 202 community-dwelling adults ages 30 and older in Australia found that 14 percent reported seeing blood on the toilet paper and two percent reported seeing blood in the toilet bowl . However, 43 percent of the people seldom or never looked at either their stool or the toilet paper, suggesting that the true frequencies are higher.
●A community-based study of 1643 adults ages 20 to 64 found that 13 percent reported blood on wiping . The prevalence of any rectal bleeding was significantly higher in younger people. Only 14 percent of those with any rectal bleeding had seen a physician for bowel problems in the prior year.