Background: Lower gastrointestinal bleeding (LGIB) is a frequently encountered condition with diverse etiologies, including both benign conditions, such as hemorrhoids, and malignant ones, such as colorectal cancer. Colonoscopy remains the gold standard for diagnosing LGIB. This study intends to evaluate the colonoscopic findings in patients presenting with LGIB and recognise the impact of alarming features, such as age over 50 years, anemia, weight loss, and family history of colorectal cancer, on these findings. Objectives: This study examines colonoscopic findings in LGIB patients, emphasizing on associations between alarming features and serious diagnoses like colorectal cancer. Methods: We conducted an observational, cross-sectional study from August 2021 to July 2022 at the Gastroenterology Department of Bir Hospital, Kathmandu. Sixty patients with LGIB were included, with or without alarming features. Statistical analysis was performed using SPSS version 22, and chi-square tests were used to assess correlations. Results: Among the 60 patients, 63.3% were male, and the mean age was 47.97 ± 16.22 years. Hemorrhoids (33.3%) and colorectal cancer (21.7%) were the most frequent findings. Alarming features were associated with colorectal neoplasms (p < 0.05), predominantly found in the left colon. Conclusion: This study shows hemorrhoids and colorectal cancer as leading causes of LGIB. Alarm features strongly correlate with colorectal neoplasms, supporting the recommendation of early colonoscopy in patients presenting with these symptoms.