Aspects of the history can help to differentiate between the various anorectal pathologies (Table 1).

With external haemorrhoids or rectal prolapse, other symptoms include:

  • Itch
  • Discharge
  • Swelling
Table 1: Anorectal pathologies



Haemorrhoids Normally painless, unless thrombosed [3] Tend to cause bright red blood on stool or pan [1-2]
Anal fissure Severe pain on defecation lasting for 1-2 hours after [5] Small amount of bright red blood on paper [1-2]
Anorectal abscess Pain worse on defecation or sitting; a tender swelling; deep pain or buttock pain depending on location of abscess [1] Small amounts of blood or pus per rectum (PR) may occur if fistula is present
Rectal prolapse Normally painless, unless strangulated Blood-stained mucus PR [4]