How are hemorrhoids diagnosed?

Usually, an explanation of your symptoms is an important clue to your doctor. On examination, external hemorrhoids and bulging hemorrhoids may be visible.

When hemorrhoids are not visible beyond the anus, your doctor will examine the inside of the anal canal using a lighted instrument called an anoscope.

Often, your doctor will recommend a detailed examination of your sigmoid colon and rectum using a lighted scope (a procedure called flexible sigmoidoscopy) to ensure that there is no inflammatory disease, such as Crohn's disease or ulcerative colitis, or any cancer.

A thorough evaluation and proper diagnosis by the doctor is important in diagnosing hemorrhoids, and any time bleeding from the rectum or blood in the stool occurs. Bleeding may also be a symptom of other digestive diseases, including colorectal cancer, bleeding ulcers, inflammatory bowel diseases (such as Crohn's disease and ulcerative colitis), and anal tears.

A doctor will examine the anus and rectum to look for swollen blood vessels that indicate hemorrhoids and will also perform a digital rectal exam with a gloved, lubricated finger to feel for abnormalities.

Closer evaluation of the rectum for hemorrhoids requires an exam with an anoscope. An anoscope is a hollow, lighted tube useful for viewing internal hemorrhoids. A proctoscope is more useful for completely examining the entire rectum.

To rule out other causes of gastrointestinal bleeding, the doctor may examine the rectum and lower colon, or sigmoid, with sigmoidoscopy or the entire colon with colonoscopy. Sigmoidoscopy and colonoscopy are diagnostic procedures that also involve the use of lighted, flexible tubes inserted through the rectum.

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A doctor can evaluate symptoms of hemorrhoids to rule out other, more serious problems. A number of conditions that affect the anus and colon (large intestine) can cause bleeding, mucus drainage, itching and discomfort. Most people who have these symptoms think they have hemorrhoids, but often they do not.

If hemorrhoids are present, the doctor will evaluate their location and size and develop a treatment plan based on the hemorrhoids' degree of severity.

The diagnosis of hemorrhoids is based on a medical history and physical exam. A digital rectal exam and an anoscopy may be the only tests needed at first. Your doctor will decide which tests to use. If hemorrhoids are the obvious cause of rectal bleeding, you are younger than age 50 and you do not have risk factors for colon cancer, you may not need more tests.

To make sure nothing else (like colon cancer) is causing your symptoms, you may need other tests, such as:

• Flexible sigmoidoscopy. This test allows a doctor to look inside the anus, rectum -- and lower part of the large intestine (colon) for abnormal growths or other signs of disease.
• Barium enema.
• Colonoscopy.

These tests are not used routinely to diagnose hemorrhoids.

Your physician will examine the perianal area for swollen blood vessels, and also perform a digital rectal exam using a gloved, lubricated finger, to detect any abnormalities in the region. He or she will also use an anoscope or proctoscope to view the anal tract.

To rule out other causes of bleeding, your physician may examine the entire colon or large intestine with colonoscopy, or just the bottom section, using sigmoidoscopy.