Dr Gregory Tarr. Interventional Radiology

Symptom score

Haemorrhoid bleeding score

The Haemorrhoidal Bleeding Score is a short measure of how much bleeding from haemorrhoids is affecting you. It is the outcome measure used in studies of haemorrhoidal artery embolisation. It takes under two minutes.

This questionnaire does not diagnose anything

It measures how severe and how troublesome your symptoms are right now. It cannot tell you what is causing them, it cannot tell you whether you have haemorrhoids, and it cannot decide whether embolisation or any other treatment is right for you. Only a consultation, an examination and the appropriate tests can do that.

If this is urgent, do not use this page

Heavy or continuous rectal bleeding, black tarry stools, dizziness or fainting need urgent assessment — go to your nearest emergency department or call 000. Rectal bleeding should never be assumed to be haemorrhoids: any change in bowel habit, unexplained weight loss, or bleeding in someone over 45 or with a family history of bowel cancer needs to be assessed by a doctor, usually with a colonoscopy.

This page provides no emergency or urgent clinical assessment, and nobody monitors it outside consulting hours.

What this score measures

Four areas: how often you bleed (0–2), how much you bleed (0–2), whether the bleeding has affected your iron levels or blood count (0–3), and how much discomfort the haemorrhoids cause you (0–2).

The four are added to give a total from 0 to 9. A higher score means a greater burden from haemorrhoidal bleeding. In the study that validated the score, nobody scoring 3 or below was advised to have surgery, while about three-quarters of those scoring 7 or more were.

Discomfort is rated on a 0 to 10 scale and then converted: 0–3 counts as little or no discomfort, 4–6 as moderate, and 7–10 as frank or permanent discomfort.

Scoring follows Table 1 of Fathallah N et al., “Proposal for a New Score: Haemorrhoidal Bleeding Score”, Annals of Coloproctology 2021;37(5):311–317. In that study the score was validated in 100 consecutive patients, agreement between two proctologists was near-perfect (weighted kappa 0.98), no patient scoring 3 or below had an indication for surgery, and a score above 5 best separated those offered surgery from those managed medically. The same score is used in the published haemorrhoidal embolisation series, where it is sometimes called the French or Paris bleeding score. One difference to note: in that study a specialist completed the score after interviewing the patient, using blood test results for the anaemia question. Here you are answering it yourself, so treat the iron and anaemia question as your best understanding and bring it to your doctor.

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About this entry

This only changes which questions you are asked. It does not change your score.

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Bleeding

1How often do you notice bleeding?

Bleeding frequency

2When you do bleed, where do you see the blood?

Type of bleeding

Effect on your blood count

3Has the bleeding affected your iron levels or blood count?

Iron deficiency or anaemia

Discomfort

4Overall, how much discomfort do your haemorrhoids cause you?

Rated 0 to 10, then converted to the score's 0 to 2 discomfort band

0 — none10 — worst imaginable

A little more detail

Optional. These do not change your score.

How bad is your pain from the haemorrhoids?
0 — none10 — worst imaginable
How bad is itching around the anus?
0 — none10 — worst imaginable
If you have been told the grade of your haemorrhoids, which is it?

Prolapse grade

Are you currently taking iron tablets?

Since your last review

These questions only apply at a follow-up review.

Have you needed an iron infusion since your last review?
Have you needed a blood transfusion since your last review?
Have you had any further haemorrhoid procedure since your last review?
Overall, how are your haemorrhoid symptoms compared with before your treatment?
How satisfied are you with the result of your treatment?

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Common questions

What is the Haemorrhoidal Bleeding Score?

It is a short score, from 0 to 9, that combines how often you bleed, where you see the blood, whether your iron or blood count has been affected, and how much discomfort you have. It was published in Annals of Coloproctology in 2021 by a Paris proctology group and validated in 100 consecutive patients, with near-perfect agreement between two specialists scoring the same patients. It is the measure used in the published haemorrhoidal embolisation series, where you may see it called the French or Paris bleeding score.

Why does the discomfort question use a 0 to 10 scale?

Because that is how the score was designed. You rate your discomfort from 0 to 10, and the score converts it: 0 to 3 counts as little or no discomfort, 4 to 6 as moderate, and 7 to 10 as frank or permanent discomfort. Doing the conversion for you avoids the guesswork of choosing a category.

The anaemia question mentions iron deficiency — how would I know?

From a blood test. In the original score, iron deficiency means a ferritin below 30, and anaemia means a haemoglobin below 130 g/L in men or 120 g/L in women. If you have not had these checked recently, answer as best you can and bring the question to your GP — a full blood count and iron studies are part of any proper assessment of rectal bleeding.

Could my bleeding be something other than haemorrhoids?

Yes, and this is important. Bowel cancer, polyps, inflammatory bowel disease and anal fissures can all cause rectal bleeding. No score can distinguish between them. Rectal bleeding needs a doctor's assessment, and often a colonoscopy, before it is put down to haemorrhoids.

What is haemorrhoidal artery embolisation?

It is a keyhole procedure performed through a small puncture, usually in the wrist or groin, that reduces the arterial supply to the haemorrhoidal cushions. It is aimed particularly at bleeding, is done without a general anaesthetic in most cases, and avoids wounds in the anal canal. It may reduce or delay the need for surgery in suitable patients.

Does a low score mean I do not need to be seen?

No. A low score means the bleeding is not currently causing a large burden. It says nothing about the cause. If you are bleeding at all and have not been assessed, see your GP.

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Medically reviewed by Dr Gregory Tarr, MB ChB, PhD, FRANZCR, EBIR
Reviewed 25 July 2026 · next review due July 2027 · instrument: Haemorrhoidal Bleeding Score

Questionnaire wording, scoring and interpretation clinically approved by Dr Gregory Tarr on 25 July 2026. Items and point values verified against the source publication on 25 July 2026.

This page is general information for Australian patients and their doctors. It is not a substitute for individual medical advice.