The diagnostic value of squirting rectal bleeding: The first description of such bleeding pattern

Background and objective: Rectal bleeding is a common symptom that has many patterns, but none of them are accurately diagnostic. One newly noticed pattern can be diagnostic, namely, the squirting pattern, for which this study was conducted. Methods: The study was conducted between Jan 2013 and Jun 2018, including 132 patients who presented with a squirting pattern of rectal bleeding, which is thought to be due to hemorrhoids. All these patients underwent clinical evaluation and anoscopy, and the majority (n=94) underwent colonoscopy. Results: At the time of clinical examination, 23 patients showed actively bleeding hemorrhoids. Fifteen patients were not convinced to undergo colonoscopy. The rest (n=94) who had no visible active bleeding at the time of examination underwent a colonoscopy to exclude other possible rectal or colonic pathology. All the 94 colonoscopies were negative for other bleeding sources. Two patients showed single benign non bleeding polyps, which were excised and biopsied. Conclusion: This study highlights a pattern of rectal bleeding that is not described before and proved it is a reliable diagnostic pattern for hemorrhoids. It also showed that colonoscopy is not needed in patients below 40 years complaining of squirting rectal bleeding unless indicated for some other reason. This decision is to be made very carefully. Keywords: Squirting rectal bleeding; Hemorrhoids; Colonoscopy.