1[] Hemorrhoids
2[] Pain
3[] Bleeding
4[] Constipation
5[] Bowel trouble
6[] Blood in stool
7[] Ulcers
8[] Other (Specify) ____
9[] DK/Refused

1 [] Hemorrhoids
1 [] Bleeding
1 [] Pain
1 [] Constipation
1 [] Bowel trouble
1 [] Blood in stool
1 [] Ulcers
1 [] Unrelated medical problem
1 [] Other
1 [] DK