Diagnosis of Hemorrhoids

How are hemorrhoids diagnosed?

Your doctor can often diagnose hemorrhoids based on your medical history and a physical exam. He or she can diagnose external hemorrhoids by checking the area around your anus. To diagnose internal hemorrhoids, your doctor will perform a digital rectal exam and may perform procedures to look inside your anus and rectum.

Medical history

Your doctor will ask you to provide your medical history and describe your symptoms. He or she will ask you about your eating habits, toilet habits, enema and laxative use, and current medical conditions.

Physical exam

Your doctor will check the area around your anus for

• lumps or swelling
• internal hemorrhoids that have fallen through your anal opening, called prolapse
• external hemorrhoids with a blood clot in a vein
• leakage of stool or mucus
• skin irritation
• skin tags––extra skin that is left behind when a blood clot in an external hemorrhoid dissolves
• anal fissures—a small tear in the anus that may cause itching, pain, or bleeding

Your doctor will perform a digital rectal exam to

• check the tone of the muscles in your anus
• check for tenderness, blood, internal hemorrhoids, and lumps or masses

Procedures

Your doctor may use the following procedures to diagnose internal hemorrhoids:

• Anoscopy. For an anoscopy, your doctor uses an anoscope to view the lining of your anus and lower rectum. Your doctor will carefully examine the tissues lining your anus and lower rectum to look for signs of lower digestive tract problems and bowel disease. Your doctor performs an anoscopy during an office visit or at an outpatient center. Most patients do not need anesthesia.
• Rigid proctosigmoidoscopy. Rigid proctosigmoidoscopy is similar to anoscopy, except that your doctor uses an instrument called a proctoscope to view the lining of your rectum and lower colon. Your doctor will carefully examine the tissues lining your rectum and lower colon to look for signs of lower digestive tract problems and bowel disease. Your doctor performs this procedure during an office visit or at an outpatient center or a hospital. Most patients do not need anesthesia.

Your doctor may diagnose internal hemorrhoids while performing procedures for other digestive tract problems or during routine examination of your rectum and colon. These procedures include colonoscopy and flexible sigmoidoscopy.