Which hemorrhoids are associated with rectal bleeding without pain?

• A. External hemorrhoids
• B. Internal hemorrhoids
• C. Thrombosed hemorrhoids
• D. Sentinel hemorrhoids

Answer: (B)

Internal hemorrhoids are the type associated with rectal bleeding without pain. These hemorrhoids are located above the anal canal and are not innervated by sensory nerves, making them less likely to cause pain compared to their external counterparts. When internal hemorrhoids become engorged with blood, they can bleed during bowel movements, especially if there is straining, leading to bright red blood in the stool or on toilet paper.

In contrast, external hemorrhoids, which are found below the dentate line and are rich in sensory nerve endings, can be quite painful, especially if they become thrombosed or inflamed. Thrombosed hemorrhoids typically present with acute pain, swelling, and sometimes bleeding when they rupture. Sentinel hemorrhoids are typically secondary to a chronic anal fissure and can also cause discomfort and bleeding.

Thus, internal hemorrhoids are characterized by painless rectal bleeding, distinguishing them from the other types listed.