PR Bleeding and/or Haemorrhoids

The Department will periodically contact patients waiting for an outpatient clinic appointment via SMS, with a link to an electronic form.  This is part of routine waitlist auditing to ensure patient details are up to date.  If you receive this SMS, please update your details.


North South North West Statewide

Pre-referral work-up


  • Refer for colonoscopy if underlying disease is suspected
  • All referrals should comply to the referral standards and include:
    • An associated change in bowel habit
    • Blood mixed with stool
    • Palpable mass on rectal examination
    • Associated pain and discomfort in the absence of thrombosis or other pathology such as a fissure
    • Copious bleeding with associated anaemia
    • Note if there is any high risk family history
    • Pathology results, Essential: FBE and if anaemic please provide iron studies & B12
    • BMI (or height & weight) and use of anticoagulants or iron supplements
    • If possible please complete the PR Bleeding Patient Questionnaire and fax with your referral. This questionnaire can be downloaded as a PR Bleeding Patient Questionnaire - PDF version or using the PHT referral template which you can download into your practice software.


  • PR examination and results
  • Check for prolapse and thrombosis of haemorrhoids
  • Include if any, level of suspicion of underlying malignancy

Interim/GP management

To refer a patient with this condition, please see the Colorectal Surgery clinic page for the full referral process and templates.

Symptom management advice should be offered for patients without suspicious symptoms such advice might be a high fibre diet for internal haemorrhoids,  and a glyceryl trinitrate based ointment for an anal fissure.

Review patients if symptoms change.

Related information found in the Gastroenterology and General Surgery guidelines.

For more information please see the Tasmanian Health Pathways website.

Urgent / category 1

Blood mixed in with stool



Weight loss

Abdominal Mass

Iron deficiency anaemia +/- positive FOBT

Semi-urgent / category 2

Change in bowel habit (To looser stools and/or increased frequency of defecation persistent for 6 weeks)

High risk family history (1st degree relative < 50 years of age at onset of colorectal cancer OR more than one 1st degree relative with colorectal cancer)

Where there has been a recent benign colonoscopy and unexplained or recurrent rectal bleeding

Positive FOBT

Routine / category 3

< 40 years of age with chronic haemorrhoidal type bleeding (no change in pattern)

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.


Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.


Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within four weeks, or sooner if clinically indicated.