On performing the per rectum (PR) examination, the following were noted:

• External Hemorrhoids: Clear, visible external hemorrhoids around the anal verge with mild protrusion.
• No evidence of internal hemorrhoids detected upon palpation.
• The anal sphincter tone was normal with no abnormal laxity or tightness.
• No palpable rectal masses, lesions, evidence of perianal Crohn’s disease or signs of abnormal structures within the rectum.

Mild bleeding (e.g., small amount of bright red blood on toilet paper) may be related to hemorrhoids or minor inflammation in the rectum. In general, if external hemorrhoids are the only finding and the bleeding is mild, further investigations may not be immediately necessary. If the patient has no other concerning symptoms, it may not require imaging, and conservative management (e.g., dietary changes, stool softeners) may be enough.

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