It is always very upsetting, and sometimes frightening for anyone to see blood in the toilet bowl or on the tissue after having a bowel movement. There are multiple factors that can lead to this. Disease processes which have been known to cause rectal bleeding include but are not limited to the following: diverticular disease, colorectal polyps, colorectal cancer, anal cancer, inflammatory bowel disease, colitides (infectious, ischemic, radiation), colonic vascular malformations, hemorrhoids. This normally should not be ignored and would require thorough follow-up and investigation. We offer a systematic approach in evaluating each case and offer treatment recommendations accordingly.