Background: Rectal bleeding is considered an important sign of colonic disease, particularly colorectal cancer. Rectal bleeding is considered to be an alarm feature in particular for colorectal cancer that, in tum, is the second- leading cause of cancer death globally. Colonoscopy has been reported recently as cost effective method of evaluating asymptomatic rectal bleeding 14, while rectal bleeding as a diagnostic indicator has been questioned in general practice. Objective: The objective of this study is to determine the frequency of common causes of bleeding per rectum among patients presenting to surgical OPD at tertiary care hospital. Materials and Methods: This descriptive cross sectional study was carried out at Department of General Surgery Hayatabad Medical Complex Peshawar from September 2021 to March 2022. Total of 164 patients with lower GI bleed were included in the study. All patients were enrolled in a consecutive manner and subjected to lower GI proctoscopy, other relevant investigations to detect the cause of GI bleed. Results: Total 164 patients were included. Age ranged between 15-60 years with a mean age of 37.5 years. There were 107(65.2%) male and 57(34.8%) female, with a male to female ratio of 1.9:1. Age distribution was analyzed as 63(38.4%) belongs to age group of 20-30 years, 30(18.3%) in 30-40 years, 26(15.9%) in 40-50 years and 45(27.4%) in age group 50-60 years respectively. On proctoscopy, hemorrhoids were found in 54(32.9%) patients, colitis in 15(9.1%), inflammatory bowel diseases (IBD) in 39(23.8%), ulcerative colitis in 29(17.7%), diverticular diseases in 10(6.1%) and abdominal TB in 17(10.4%). None of the patients had colorectal cancer. Conclusion: Hemorrhoids, inflammatory bowel diseases and ulcerative colitis were common causes of lower gastrointestinal bleed in our population and ulcerative colitis was significantly high in female patients.