Haemorrhoids can present in a variety of ways.

Presentations:

1. Bleeding – either blood on the toilet paper or blood dripping on the toilet bowl. The latter can be quite alarming for the patients

2. Palpable lump – usually comes out after one opens the bowels and can either go back in spontaneously or needs to be pushed back in

3. Pain – uncommon. This is caused by a thrombosed haemorrhoid (the blood in the dilated blood vessel within the haemorrhoid becomes clotted)  The pain can be severe especially in the first 3 days.  After that, as the swelling subsides, the pain reduces.  On examination, one can find a large swollen tender lump in the perianal area