Rectal Bleeding / Positive FOBT

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


All referrals should comply with referral standards and include in particular:

  • Duration of symptoms
  • Reason for doing FOBT- screening? (NBCSP) If the patient has a positive National Bowel Cancer Screening Service Result, please indicate this clearly on referral
  • Weight loss, abdominal pain or other symptoms
  • Blood mixed in with stool
  • If the patient is taking hypoglycaemic agents, anticoagulants of any sort or iron supplements. Please indicate this and the reason for their use.
  • Pathology results, Essential: FOBT result, FBE, Iron Studies and consider B12
  • BMI (or height & weight)
  • Please provide other information if present such as, morbid obesity, inability to read or understand English, likely inability to self-manage colonic preparation.
  • If possible please complete the PR Bleeding Patient Questionnaire and include with your referral. This questionnaire can be  downloaded as a PDF version or using the PHT referral template which you can download into your practice software.




iron studies



Any relevant


Rectal examination result

Interim/GP management

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

Also look at general surgery and colorectal surgery guidelines

For more information please see the Tasmanian Health Pathways website.


Potentially life-threatening symptoms suggestive of:

  • acute upper GI tract bleeding
  • acute severe lower GI tract bleeding
  • oesophageal foreign bodies/food bolus
  • bowel obstruction
  • abdominal sepsis
  • Acute Severe Colitis - see note

Severe vomiting and/or diarrhoea with dehydration
Acute/fulminant liver failure (to be referred to a centre with dedicated hepatology services
Biliary sepsis (to be referred to a centre with ERCP service)

Note: Acute severe colitis as defined by the Truelove and Witts criteria – all patients with ≥ 6 bloody bowel motions per 24 hours plus at least one of the following:

  • temperature at presentation of > 37.8°C,
  • pulse rate at presentation of > 90 bpm,

haemoglobin at presentation of < 105 gm/l, CRP >30mg/dl at presentation (or ESR > 30 mm/hr)

Urgent / category 1

Rectal bleeding with any of the following concerning features :

  • dark blood coating or mixed with stool
  • weight loss, ≥5% of body weight in previous 6 months
  • abdominal / rectal mass
  • iron deficiency in males and postmenopausal women or unexplained iron deficiency in premenopausal women
  • patient and family history of bowel cancer (1st degree relative <55 years old)

Semi-urgent / category 2

Rectal bleeding without concerning features (as above)

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.


We will endeavour to see these patients within four weeks

Urgent referrals should be accompanied by a phone call to the clinic and the relevant doctor for urgent assessment, or patient should be directed immediately to the Emergency Department.


We will endeavour to see these patients within 12 weeks


Next available appointment