How are hemorrhoids diagnosed?

Hemorrhoids can often be diagnosed by a physical examination of the anus along with a review of your medical history and symptoms. The healthcare provider may also perform a digital rectal exam in which a gloved and lubricated finger is inserted into the rectum.

What kind of healthcare provider diagnoses hemorrhoids?

Your primary care healthcare provider is usually able to diagnose hemorrhoids. However, if the hemorrhoid is internal, you may be referred to a gastroenterologist who can use an anoscope or proctoscope to examine the lining of the lower rectum and colon. This can also help the healthcare provider see if you have any lower digestive tract problems or bowel disease.

What is involved in the diagnosis of internal hemorrhoids?

Anoscopic and proctoscopic exams are both performed on an outpatient basis, usually without anesthesia . Bowel preparation is generally not required for an anoscope, but an enema may be needed the night before a proctoscopic exam. Both exams may cause minor discomfort but usually only take a few minutes to complete.

Can you self-diagnose hemorrhoids?

Sometimes. External hemorrhoids can usually be recognized by symptoms such as pain, swelling, itching, and bleeding. Internal hemorrhoids may be harder to self-diagnose as they are typically painless. In some cases, rectal bleeding may be the only sign of an internal hemorrhoid. At other times, an internal hemorrhoid may bulge (prolapse) outside of the anus.

What can be mistaken for hemorrhoids?

There are many conditions that mimic hemorrhoids, some of which may be serious. This is why it’s important to see a healthcare provider if the symptoms do not resolve with conservative treatment . Among the conditions commonly mistaken for hemorrhoids are: Anal fissure Anal fistula Anal abscess Genital warts Skin tags Prostatitis Inflammatory bowel disease (IBD) Colorectal polyps Rectal prolapse Anal cancer

How Hemorrhoids Are Diagnosed

Hemorrhoids may feel embarrassing to address, which is why many people try to diagnose themselves and avoid seeing a healthcare provider. However, it’s important to see a healthcare provider to get a proper diagnosis and treatment. Hemorrhoids can have symptoms similar to other, more serious conditions, and those should be ruled out before assuming symptoms are from hemorrhoid. In most cases, hemorrhoids can be easily diagnosed with a history and a physical exam.

hemorrhoids diagnosis — © Verywell, 2018

Self-Checks/At-Home Testing

There are two types of hemorrhoids: internal and external. Internal hemorrhoids are located in the rectum and can’t be seen by looking at the area unless they prolapse (slip out outside of the anus). External hemorrhoids are around the anus and can be seen or felt.

Unless hemorrhoids have been a problem in the past, most people may find it difficult to identify hemorrhoids by sight or feel alone.

Physical Tests

In many cases, a hemorrhoid is going to be diagnosed with a physical exam that includes either a look at the outside of the anus or a rectal exam. There may be certain circumstances, however, where seeing inside the anal canal is needed to diagnose internal hemorrhoids.

Rectal Exam

A rectal exam is a typical way to diagnose hemorrhoids, although many people may be worried about having this test because of potential embarrassment. However, healthcare providers perform these tests routinely and will work to ensure that patients feel as comfortable as possible.

For this test, patients are asked to remove their clothing from the waist down and change into a hospital gown or are given a paper drape sheet to cover up with until the exam begins. With gloved hands, the healthcare provider will examine the anus and the perianal area, which is the skin around the anus.

A rectal exam is performed quickly and shouldn’t cause any significant pain.

It may also be necessary to insert a finger inside the anus. This is done to feel the structures inside and determine if there are any internal hemorrhoids. However, it may not always be possible to feel internal hemorrhoids with a finger, so a rectal is not always definite. In addition, a healthcare provider will be able to see if any blood or mucus comes away on the glove, which will help in making a diagnosis.

Anoscopy

In some cases, a healthcare provider may use a device called an anoscope to look inside the rectum. An anoscope is a short, narrow tube with a light on it that can be inserted into the rectum. By using this device, a healthcare provider can have a more complete look at the structures inside and see if hemorrhoids are present or if there is another explanation for the symptoms.

An anoscopy may cause brief discomfort, but not pain, and it is over in a minute or two.

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Differential Diagnoses

When hemorrhoids cause pain and bleeding, it might be necessary to rule out other conditions that may cause similar symptoms.

Polyps in the colon and colorectal cancer may also cause rectal pain and bleeding, especially in people over the age of 50.

Anal Fissure

An anal fissure is a tear in the lining of the anal canal. It causes pain, especially during a bowel movement, and bleeding. Most anal fissures heal on their own with home treatment.

Anal Fistula

An anal fistula is an abnormal connection between the bowel and the perianal skin. It can be painful and usually starts as an abscess, which is a collection of pus under the skin. During a rectal exam, a healthcare provider will be able to see if there’s an anal fistula present.

Polyps

Polyps are more common in the colon for people over the age of 50 years, but they can occur in younger people as well. Polyps usually cause no symptoms and are only discovered during a colonoscopy, but they may also cause bleeding.

Your healthcare provider may want to do other tests, like a colonoscopy or a sigmoidoscopy, to confirm rectal bleeding is being caused by hemorrhoids and not a colorectal polyp.

Inflammatory Bowel Disease (IBD)

IBD, Crohn’s disease, ulcerative colitis, and indeterminate colitis may also cause bleeding in the digestive tract and could additionally be associated with hemorrhoids.

If there are other symptoms present with the bleeding, such as diarrhea or abdominal pain, a healthcare provider may decide to do other tests to rule out IBD as a secondary cause of the bleeding.

Frequently Asked Questions

How are hemorrhoids diagnosed?

Hemorrhoids can often be diagnosed by a physical examination of the anus along with a review of your medical history and symptoms. The healthcare provider may also perform a digital rectal exam in which a gloved and lubricated finger is inserted into the rectum.
What kind of healthcare provider diagnoses hemorrhoids?

Your primary care healthcare provider is usually able to diagnose hemorrhoids. However, if the hemorrhoid is internal, you may be referred to a gastroenterologist who can use an anoscope or proctoscope to examine the lining of the lower rectum and colon. This can also help the healthcare provider see if you have any lower digestive tract problems or bowel disease.
What is involved in the diagnosis of internal hemorrhoids?

Anoscopic and proctoscopic exams are both performed on an outpatient basis, usually without anesthesia. Bowel preparation is generally not required for an anoscope, but an enema may be needed the night before a proctoscopic exam. Both exams may cause minor discomfort but usually only take a few minutes to complete.
Can you self-diagnose hemorrhoids?

Sometimes. External hemorrhoids can usually be recognized by symptoms such as pain, swelling, itching, and bleeding. Internal hemorrhoids may be harder to self-diagnose as they are typically painless. In some cases, rectal bleeding may be the only sign of an internal hemorrhoid. At other times, an internal hemorrhoid may bulge (prolapse) outside of the anus.
What can be mistaken for hemorrhoids?
There are many conditions that mimic hemorrhoids, some of which may be serious. This is why it’s important to see a healthcare provider if the symptoms do not resolve with conservative treatment. Among the conditions commonly mistaken for hemorrhoids are:
- Anal fissure
- Anal fistula
- Anal abscess
- Genital warts
- Skin tags
- Prostatitis
- Inflammatory bowel disease (IBD)
- Colorectal polyps
- Rectal prolapse
- Anal cancer

How Hemorrhoids Are Treated

8 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

London S, Tichauer MB. Anoscopy. StatsPearls Publishing.
Beaty JS, Shashidharan M. Anal Fissure. Clin Colon Rectal Surg. 2016;29(1):30-7. doi:10.1055/s-0035-1570390
Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015;21(1):12-20. doi:10.3748/wjg.v21.i1.12
Pendergrass CJ, Edelstein DL, Hylind LM, et al. Occurrence of colorectal adenomas in younger adults: an epidemiologic necropsy study. Clin Gastroenterol Hepatol. 2008;6(9):1011-5. doi:10.1016/j.cgh.2008.03.022
National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of GI Bleeding.
National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of hemorrhoids.
Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clinics Colon Rectal Surg. 2016;29(01):022-9. doi:10.1055/s-0035-1568144
Herold A. Differential diagnosis of hemorrhoidal disease. Hautarzt. 2020;71(4):269-74. doi:10.1007/s00105-020-04553-y

By Amber J. Tresca
Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16.

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