A 50-year-old male with a history of chronic constipation presents with complaints of bright red rectal bleeding and pruritus ani (anal itching). He denies any significant pain. What are the possible causes and next steps?
Given this patient's history of chronic constipation and his symptoms of rectal bleeding and anal itching, the most likely diagnosis is internal hemorrhoids. Hemorrhoids can be irritated by the passage of hard stool, leading to bleeding, and can cause anal itching. The next steps would include a physical examination, including a digital rectal examination and potentially an anoscopy or proctoscopy, to confirm the presence of hemorrhoids. Treatment would primarily focus on relieving symptoms and might include fiber supplements, stool softeners, topical treatments, and measures to address the underlying constipation.