Bleeding is a common means of presentation of haemorrhoids. The cause is typically trauma from the stool, toilet paper or clothing that triggers a bright red bleed. The blood is fresh due to its origin from the capillaries within the vascular cushions.
First and second-degree haemorrhoids bleed at the time of the bowel movement. This is because the anal sphincter remains tonically contracted at other times. Often, it is described as a steady drip of blood after the stool has passed. This blood should disperse within the pan.
Blood attached to the surface of the stool that does not look fresh is unlikely to be from haemorrhoids. The same applies to the passage of clots or altered blood.
Third and fourth-degree haemorrhoids may present with bleeding unrelated to the passage of stool. The volume of blood lost may be large.
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