Snapshot A 59-year-old man comes to the clinic for complaints of blood in stool for the past month. He also reports a ping-pong sized mass at the anus. When asked to describe the stool, he claims that there are “streaks of bright red blood” on top of the stool that is not mixed in. He denies pain, melena, history of colon cancer, or weight loss. His last colonoscopy was done 8 years ago and was unremarkable. Introduction Clinical definition login to view 11 more bullets Epidemiology Demographics login to view 2 more bullets Risk factors login to view 7 more bullets ETIOLOGY Pathogenesis login to view 6 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 3 more bullets IMAGING Anoscopy login to view 3 more bullets Colonoscopy/flexible sigmoidoscopy login to view 1 more bullet Studies Diagnostic testing login to view 5 more bullets Differential Anal fissures login to view 2 more bullets Colorectal pathology (e.g., polyps) login to view 2 more bullets Treatment First-line login to view 9 more bullets Second-line login to view 6 more bullets Third-line login to view 2 more bullets Complications Exsanguination (may not have signs of external bleeding) Pelvic infection Incontinence Thrombosis Strangulation Ulceration Infection Anal fissures