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Anal pain – what would you do?

Chief Complaint “anal pain”
Paul J is a 52 year old male.
History of Present Illness
#1. “anal pain”
Duration
He reported: Rectal pain duration minutes.
Timing
He reported: Pain in the back passage that comes and goes 1-7 times per week.
Rectal pain comes and goes.
Severity
He reported: Rectal pain discomforting at its worst.
Quality
He reported: Loose stools. Constipation sometimes. Change in consistency of
stools. Pain in the back passage. Swelling around back passage. Itching around
the back passage. Fullness or pressure in the back passage. Painful bowel
movements. Loss of bowel control. Rectal bulge during bowel movements.
Stools mixed or streaked with blood sometimes. Blood on the surface of the stools.
He denied: Stools black or maroon. Change in number of bowel movements.
Haemorrhoids (piles).
Context
He reported: Bowel movements changed in the last 6 months.

GPs, what would you do first?

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