Abstract Rectal bleeding is a very common symptom, with the majority of cases being caused by benign conditions. However, a small but significant percentage of those over 40 will have an underlying colorectal cancer. A careful clinical history is important in making a diagnosis and aiding in the choice of further investigations. These investigations range from flexible sigmoidoscopy, barium enema and colonoscopy to the more recent introduction of virtual colonoscopy and CT colonography. Presentations have been altered by NICE referral guidelines and the introduction of the NHS Bowel Cancer Screening Programme. Management depends on the cause and varies from the conservative through clinic-based procedures to formal surgical interventions.