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blood is noted on toilet tissue and sometimes in the toilet bowl Internal hemorrhoids may be uncomfortable but are not as painful as thrombosed external hemorrhoids Internal hemorrhoids sometimes cause mucus discharge and a sensation of incomplete evacuation External hemorrhoids (below dentate line): Pain, but no bleeding External hemorrhoids may become thrombosed, resulting in painful, purplish swelling Rarely they ulcerate and cause minor bleeding

Darweesh RS, Ayoub NM, Nazzal S

The patient developed rapid heart and respiratory rates, headaches, and night blindness, and ultimately became comatose

Always use sterile saline from a sealed vial never tap water or non-sterile diluents