Under 40 with blood on stool and paper. DRE found no evidence of hemorrhoid. Next step? Is colonoscopy needed?

Consider risk. Most likely source is anus: have Proctologist do anoscopy first, could be fissure without hemorrhoid. Blood could be coming from rectum or higher. A colonoscopy would be reasonable if the anoscopy does not show anything. Take it seriously until you know the cause. Cancer is possible even in people under 40, but not likely.

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