Children may present with altered bowel habit and/ or rectal bleeding

Classical haemorroidal disease is relatively rare in children. Painful bright red rectal bleeding is much more common since constipation is a relatively common childhood disorder. The hard stool causes a tear of the ano-rectal mucosa with subsequent fissure. The pain from the fissure must be addressed promptly or the child will delay defecation and this fissure will worsen.

Inflammatory bowel disease may present in a similar pattern in paediatric practice with altered bowel habit (usually diarrhoea) and bleeding. Systemic features may be present and investigation with an endoscopy may be required.

Children with intussceception usually present at a relatively young age and the history is usually one of colicky abdominal pain, together with a mass on clinical examination.The often cited red current jelly type stool is a rare but classical feature.

Juvenile polyps may occur as part of the familial polyposis coli syndromes. The lesions, which are hamartomas, are often cherry red if they protrude externally.