Bleeding and protrusion are among the most common symptoms of hemorrhoids. However, Mazier reported on a series of 500 patients with complaints of “hemorrhoids” and found that only one third had any significant hemorrhoids (personal communication). hemorrhoids bleeding typically results in bright red blood that drops into the toilet or is noted on the toilet. It is generally painless. More vigorous bleeding can occur as the hemorrhoids enlarge. Usually, prompt reduction of the protruding mass will cause this bleeding to abate. Acute thromboses of internal or external hemorrhoids are usually associated with severe pain that occurs with a palpable perianal mass. These patients are generally very uncomfortable, and the diagnosis is immediately obvious on clinical examination…