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Haemorrhoids — MCCQE Part 1 MCQ

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EasyRectal BleedingHaemorrhoidsMCCQE Part 1

34-year-old woman postpartum presents with bright red blood on toilet paper. She has anal pain and external haemorrhoids, no weight loss and normal haemoglobin. Which of the following is the most appropriate next step?

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Correct answer: C — Treat conservatively with fibre, fluids and topical symptom relief while safety-netting

Treat conservatively with fibre, fluids and topical symptom relief while safety-netting is best because postpartum painful bright red bleeding with visible haemorrhoids is usually benign. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Persistent or unexplained bleeding still requires reassessment.

Reference: Canadian Association of Gastroenterology guidance