Haemorrhoids may present in many ways including;
If defectation is severely painful then the problem is more likely due to a fissure than to haemorrhoids.
Pruritis ani is in the main due to irritation of the skin in the peri-anal region. Haemorrhoids occasionaly contribute to this but be cautious in assuring the patient that the itch will go if the haemorrhoids are treated, rather look upon it as a bonus if the itch improves.
Grade 2, 3 and 4 haemorrhoids are due to increasing prolapse.
Haemorrhoids may cause a mucus discharge which is sometimes stained with faecal material, this discharge may cause some peri-anal irritation and stain the underclothing.
With respect to bleeding, the characteristic is that there is no blood mixed in with the stools, but that the bleeding is often seen after passing a bowel motion, and most usually on the toillet paper. It is bright red due to its origin from the capilleries overlying the haemorrhoid. Dark red blood, of blood mixed in with the stool is usually not from haemorrhoids.