Anorectal bleeding is commonly associated with haemorrhoids but may certainly be a harbinger of many anorectal abnormalities including colorectal cancer. Any individual with rectal bleeding should undergo an appropriate, thoughtful workup to rule out rectal cancer. In a young individual with bleeding associated with haemorrhoidal disease and no other systemic symptoms, and no family history, perhaps rectoscopy and flexible sigmoidoscopy are all that is warranted. However, in an older individual, with either a family history of colorectal cancer, or change in bowel habits, a complete colonoscopy should be performed to rule out proximal neoplasia.