PR Bleeding and/or Haemorrhoids

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply to referral standards and include in particular:

  • Refer for colonoscopy if underlying disease is suspected
  • Points for concern:
    • 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
  • If possible please complete the PR Bleeding Patient Questionnaire and fax with your referral. This questionnaire can be downloaded as a 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 General Surgery clinic page for the full referral process and templates.

Symptom management advice should be offered for patients without suspicious symptoms.

Review patients if symptoms change.

Related information found in the Gastroenterology and Colorectal Surgery guidelines.

For more information please see the Tasmanian Health Pathways website.

Urgent / category 1

Blood mixed in with stool

Anaemia

Pain

Weight loss

Abdominal mass

Iron deficiency anaemia

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 <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 or a Positive FOBT

Routine / category 3

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

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

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6348 7382
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6426 5115
NWRH ED – Phone: (03) 6493 6340  Fax: (03) 6430 6691
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6222 8919

Urgent:

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:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment