Uncomplicated internal hemorrhoids are painless, and the chief complaint is painless, bright-red rectal bleeding with defecation. Bleeding is usually limited, with the blood being found on the surface of the stool, on the toilet tissue, or dripping into the toilet bowl. Although the most common cause of rectal bleeding is hemorrhoids, other, more serious causes should be sought in all patients who present with bleeding as the chief complaint. Clinical signs cannot reliably differentiate colonic lesions from hemorrhoids.1 Chronic, slow blood loss may go unnoticed but can result in a significant anemia. Pain, when present, is most severe at the time of defecation and subsides with time. Pain is usually associated with thrombosed external hemorrhoids.
As they increase in size, hemorrhoids may prolapse, requiring periodic reduction by the patient (IabJ.e...Z,8.:!,). When prolapse occurs, the patient may develop a mucous discharge and pruritus ani.
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