A 36-Year-Old Man Comes to the Office After Experiencing Intermittent

A 36-year-old man comes to the office after experiencing intermittent episodes of rectal bleeding over the past 2 months.  Initially, he noted only small streaks of blood on the tissue when wiping, but yesterday he dripped bright red blood after defecating and the stool was coated with blood.  He has had no anal or abdominal pain, nausea, vomiting, anorexia, or weight loss.  The patient has been having bowel movements every 2 or 3 days, which is unchanged from his previous routine.  He has no other medical concerns and takes no medications.  The patient's father was diagnosed with colon cancer at age 54.  Blood pressure is 130/70 mm Hg, and pulse is 80/min with no orthostatic changes.  Physical examination shows a soft and nontender abdomen with no masses or organomegaly.  Inspection of the perianal skin shows no abnormalities.  No mass or tenderness is palpable on digital rectal examination.  Anoscopy reveals purplish mucosal bulges.  Which of the following is the best next step in management of this patient?

A) Biopsy of the anal lesions
B) High-fiber diet and follow-up
C) Referral for colonoscopy
D) Referral for surgical evaluation
E) Topical nifedipine therapy

Correct Answer:

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