Not present
Present as a line/streak over the stool
Present as splash in toilet pan (more in quantity)
Other (please specify)
Bright red coloured fresh blood comes
Blackish coloured blood comes
Mixed
Present during passing stool (during defecation)
Present whole day
Present during motion
Present Always
Present about 2-3 cms away from anus
Present more than 3 cms away from anus
Less than 01 year
1-2 years
More than 02 years
Normal
Hard and dry
Loose
Irregular
Other (Please specify)
Once a day
Twice a day
More than two times in a day
Poor
Average
Good
Increased
Please specify here any other complaint/symptom other than mentioned above?
