The goal of this study was to define the whole etiological spectrum of bleeding per rectum (PR) as detected by colonoscopy and to examine its age-related distribution. The major goal was to test the hypothesis that the fundamental causes of PR differ considerably among age groups. The purpose of this study was to investigate this issue in order to provide a strong framework for enhanced clinical evaluation, risk stratification, and age-appropriate diagnostic techniques for patients with PR.

We conducted a retrospective audit of patients presenting with PR who underwent colonoscopy at our institution. A total of 752 colonoscopies performed for PR between January 2024 and mid-September 2025 were analyzed. Patients were stratified into four age groups: Children (2-16 years), Young Adults (17-40 years), Middle Age (41-60 years), and Old Age (61-85 years). All collected data were compiled and analyzed statistically using SPSS version 26.

The most common etiology overall was internal hemorrhoids (n=294, 39.1%), with its peak prevalence in Young Adults. Colorectal cancer (n=116, 15.4%) was the second most frequent finding, showing a marked increase in Middle-Aged patients. Inflammatory conditions were also prominent; Ulcerative Colitis was diagnosed in 54 patients (7.2%), primarily in Young Adults and Middle-Aged groups, while non-specific colitis accounted for 75 cases (10.0%). A notable age-dependent shift in pathology was observed: polyps were the leading finding in Children, while diverticular disease was exclusively found in Middle-Aged and Old Age patients.

Etiologies of Bleeding PR on Colonoscopy (Total Cases: 752)

The causes of rectal bleeding demonstrate a distinct and significant variation across age groups. These findings underscore the critical importance of age-stratified risk assessment and diagnostic evaluation for patients presenting with PR, which can lead to more targeted and effective clinical management.