ROSH Gastrointestinal Practice Exam

What symptom might suggest the development of complications in a patient with internal hemorrhoids?

1. Pain during bowel movements

2. Painless bright-red blood per rectum

3. Itching in the anal region

4. Swollen external hemorrhoids

The correct answer is: Pain during bowel movements

The presence of pain during bowel movements is a significant symptom that could suggest the development of complications in a patient with internal hemorrhoids. While internal hemorrhoids are often painless, the onset of pain can indicate a few possible complications, such as thrombosis or the possible progression of the hemorrhoids. It can also suggest the development of an anal fissure, which can occur concurrently with hemorrhoids. In contrast, painless bright-red blood per rectum typically does not suggest complications but rather is a common symptom associated with internal hemorrhoids themselves. Itching in the anal region can arise from irritation due to hemorrhoids but does not necessarily indicate a complication. Swollen external hemorrhoids may be a result of increased pressure and can cause discomfort, but similar to itching, they don't specifically suggest a complication arising from internal hemorrhoids. Therefore, the development of pain marks a notable shift that warrants further evaluation for possible complications.