1.WHAT ARE THE PROBLEMS YOU ARE FACING ? 1.BURNING PAIN AT ANUS2. BLEEDING DURING OR AFTER DEAFECATION3. ONLY SWELLING WHILE DEAFECATION4. ITCHING AT ANUS5.WEAKNESS AT LITTLE EXERTION6.WEIGHT LOSS7. NONE OF THESE Next2. SINCE WHEN YOU ARE SUFFERING FROM THESE PROBLEMS? 1. SINCE 1 OR 2 MONTHS OR LESS THEN THAT2.SINCE 2 – 3 YRS3.MORE THEN THAT4. NONE OF THESEBackNext3. ARE YOU SUFFERING FROM CONSTIPATION / HARD STOOL ? 1.YES2. NO3. NONE OF THESEBackNext4. HOW MANY TIMES YOU GO FOR STOOL / DEFEACATION IN A DAY? 1.NORMAL ONE TIME IN A MORNING2.2 TO 3 TIMES A DAY3. NONE OF THESE BackNext5. STOOL IS ? 1.SATISFACTORY2.UNSATISFACTORY3. NONE OF THESEBackNext 6. IS ANYTHING / SWELLING COMING OUT FROM ANUS DURING / AFTER STOOL ? 1.YES2. No3. NONE OF THESEBackNext 7. SWELLING – PLS SPECIFY 1. AUTOMATIC SUBSIDES2. REMAINS FOR SOME TIME AND THEN AUTOMATIC GOES INSIDE3. YOU PUT MANUALLY INSIDE4. REMAINS THROUGH OUT DAY5. NONE OF THESE BackNext 8. FOR HOW MUCH TIME BURNING / PAIN REMAINS AFTER DEAFECATION ? 1. FOR SOME TIME2. FOR 5 TO 6 HRS3. FOR FULL DAY4. NONE OF THESEBackNext 9. HOW YOU GET RELIEF IN BURNING / PAIN ? 1. BY APPLICATION OF HOT WATER2. BY APPLICATION OF COLD WATER3. NONE OF THESEBackNext 10. WHETHER BURNING /PAIN IS AGGRAVATED BY CONSUMPTION OF SPICY / NON VEG THINS ? 1. YES2. NO3. NONE OF THESEBackNext 11. WHAT IS YOUR NATURE OF JOB ? 1. SITTING / SEDENTARY TYPE2. TOURING JOB3. NONE OF THESEBackNext 12. WETHER YOU CONSUME OUTSIDE FOOD VERY FREQUENTLY ? 1. YES2. NO3. NONE OF THESEBackNext 13. IF ANY OTHER RELEVANT INFORMATION YOU WANT TO MENTION YOU CAN WRITE HERE SAPERATLY. BackNext 14. PLEASE ATTACH ALL THE INVESTIGATION REPORTS ( IF YOU HAVE ANY) BackNext Name Email Phone No. Back First Name *Email Address *Phone NumberMessage0 / 180Send Message First Name *Email Address *Phone NumberMessage0 / 180Send Message
