Any rectal bleeding has to be taken seriously, but the management in any particular situation must be individualised. If a patient has had a recent colonoscopy by an experienced proceduralist and has further bleeding, it may not require a repeat procedure. If the bleeding sounds anal in origin (bright red blood on the paper) and the patient had documented haemorrhoids at the last colonoscopy, it would be fairly safe to assume that these were the source of the bleeding. If the bleeding is persistent or causing the patient concern, then it would be wise to investigate this further. It is important to understand that no procedure is 100% accurate and even significant polyps or cancers can be missed by even experienced gastroenterologists. Sometimes such patients are best handled by requesting a referral for a consultation with a gastroenterologist rather than requesting a repeat colonoscopy.