Bleeding from the back passage, is most often due to piles (haemorrhoids). Although these can be troublesome and painful they are not cancers and are completely benign. But bleeding from the back passage can also sometimes be a sign of cancer.

If there is a cancer it is important to get it diagnosed and treated as soon as possible. So you should never ignore bleeding from the back passage and should not just wait and see if it goes away.

Go to see your family doctor, so that they can take all the details and examine you.

Guidelines

In England and Wales, the National institute of Clinical Excellence (NICE) has issued guidance to general practitioners. This suggests when someone with bleeding from the back passage, should have an urgent hospital appointment. An urgent hospital appointment usually means you will be seen within two weeks. You would be referred to a specialist in diseases of the digestive system (a gastroenterologist).

The guidance says: "Anyone over 40 years of age who has both bleeding from the back passage and looser stools or more frequent stools for six weeks or more should have an urgent referral to see a gastroenterologist. Anyone over 60 years of age with bleeding from the back passage for six weeks or more should have an urgent referral, regardless of whether they have other symptoms or not."

In Scotland, SIGN (the Scottish equivalent of NICE) have produced different guidelines for bleeding from the back passage. They say "anyone over 50 years of age who has

• both bleeding from the back passage and looser stools or more frequent stools for six weeks or more or
• bleeding from the back passage for six weeks or more without anal symptoms such as pain or itching

should have an urgent referral to a gastroenterologist."

More information about the NICE and SIGN guidelines.