Rectal bleeding is a common presentation to the colon and rectal surgeon's office. It is important to develop a systematic approach to its evaluation so as not to miss the presence of a malignancy. The possibility of more than one diagnosis contributing to the symptom should always be kept in mind. It may therefore be necessary to pursue the evaluation of the remainder of the colon, even in the presence of an anorectal source, depending on the risk factors in a given patient. In addition to inspection and digital exam, anoscopes and rigid procto sigmoidoscopes or flexible sigmoidoscopes are available to complete the office evaluation.