The causes of PR bleeding vary with age. It can be fresh red blood (generally indicating bleeding from the lower GI tract) or melena (generally indicating bleeding from higher up in the GI tract). In relatively well children (i.e. those not thought to need acute referral to the hospital) consider the following:
- For infants the main causes to consider are cow’s milk protein allergy and constipation with a small tear. For a breastfeeding infant consider maternal cracked nipples.
- For older children consider constipation with an anal fissure, infectious enterocolitis, polyps, and inflammatory bowel disease.
It is important to refer acutely if there are any red flag features or concerns regarding acute illness.
Conditions to be concerned about include:
In infants/young children: necrotising enterocolitis, intussusception, volvulus, Meckel’s diverticulum
In older children: inflammatory bowel disease
Any age: infective diarrhoea
