Rectal bleeding is an important symptom because the blood could be coming from an anal or rectal cancer. The most common origin of rectal bleeding, however, is the internal hemorrhoidal complex, but before treating the hemorrhoids or writing the symptom off to a benign condition, it is essential that a malignancy be excluded. Far too many patients, especially young patients, have had a rectal cancer ignored for months or even years because the bleeding was assumed to be from hemorrhoids, or diagnosed as “hemorrhoidal” without an adequate investigation. As with any symptom, an orderly work-up will lead to an accurate diagnosis and appropriate treatment. And as with any symptom, an accurate and purposeful history is extremely important.