Per rectum (PR) bleeding is a common cause of hospitalization and continues to be a problem for physicians. PR bleeding is defined as bleeding emanating from a source distal to the ligament of Treitz. Although bleeding stops spontaneously in 80% cases, 25% risk of re-bleeding persists along with a difficulty of identifying the bleeding source. Patients with major hemorrhage/ ongoing bleed require rapid diagnosis and intervention to achieve hemostasis. Refinement of Endoscopic techniques has greatly improved the diagnosis and treatment of gastrointestinal bleeds. Colonoscopy is considered to be the primary mode of diagnosis, risk analysis and treatment of few common causes of colonic bleeding. The following review discusses the etiology of PR bleeds and reviews its colonoscopic diagnosis and treatment, along with the pros and cons of colonoscopy.