Rectal physiotherapy: an unusual cause of anemia during rectal cancer follow up

A 56 y old woman who is known case of rectal cancer (T3N0) with previous history of surgery and chemo radiotherapy referred for evaluation of anemia. During her routine follow up visits, her oncologist informed about anemia (HB 10.2mg/dL, MCV 86fM), so request a full evaluation of GI tract including upper endoscopy and colonoscopy. She had not any complain except some fatigue and paleness. Her endoscopy was completely normal. During colonoscopy, the remained colon including site of anastomosis, descending, transverse, ascending and cecum sow completely normal but upon withdrawal of scope, there was brisk bleeding beside surgical sutures. The patient questioned about any bleeding and she mention rectal bleeding after sessions of rectal physiotherapy and rectal probe insertion for biofeedback therapy to prevent incontinence. So the cause of anemia diagnosed as rectal physiotherapy and biofeedback and the patient reassured and managed with intra venous iron (Ferinject 500mg). Her next follow up was totally normal without any complain.