How Hemorrhoids Are Diagnosed

A physical exam is usually done to make a hemorrhoids diagnosis

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Hemorrhoids may feel embarrassing to address, which is why many people try to diagnose themselves and avoid seeing a physician. However, it’s important to see a doctor 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.

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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.

However, unless hemorrhoids have been a problem in the past, most people aren’t going to know if the lump or bump they’re feeling or seeing is in fact a hemorrhoid.

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, physicians 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 physician will examine the anus and the perianal area, which is the skin around the anus.

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 physician will be able to see if any blood or mucus comes away on the glove, which will help in making a diagnosis.

A rectal exam may be uncomfortable for a moment or two, but it is done quickly and shouldn’t cause any significant pain.

Anoscopy

In some cases a physician 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 physician can have a more complete look at the structures inside and see if there is a hemorrhoid 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.

Differential Diagnoses

When a hemorrhoid causes pain and bleeding, it might be necessary to rule out other conditions that may cause similar symptoms. This is particularly true for people who are over the age of 50 years, because polyps in the colon and colorectal cancer may also cause bleeding, and are more common in this age group.

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 physician 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. A physician may decide to do more testing (such as a colonoscopy or a sigmoidoscopy, an exam of the large intestine) to ensure that any bleeding is from a hemorrhoid and is not from 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 physician may decide to do other tests to rule out IBD as a secondary cause of the bleeding.

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View Article Sources
  • Mott T, Latimer K, Edwards C. "Hemorrhoids: Diagnosis and Treatment Options.” Am Fam Physician. 2018;97:172-179.