Diagnosis of Hemorrhoids

Diagnosis of hemorrhoids is made on the basis of history of complaints, inspection, digital examination and direct visualization

History of complaints suggestive of hemorrhoids includes:

  •  Chronic constipation
  •  Fresh bleeding per rectum (splash in the pan)
  •  Anal discomfort
  •  Anal discharge
  •  Perianal itching

Digital examination of anal canal is done  to assess:

  • Tone of external sphincters
  •  Pain or tenderness
  •  Any thickening in the wall of the anal canal

Direct visualization of the Rectum and Anal Canal is done using

  • Proctoscope is an instrument used to  visualize the interior of the anal canal and the rectum. Internal hemorrhoids, anal fissure and any growth can be seen
  • Sigmoidoscope helps in viewing anal canal, rectum and sigmoid colon (lower part of large  intestine).
  •  Colonoscope provides a much wider view of entire colon (large intestine). Both instruments  help in ruling out other significant causes of bleeding per rectum such as Cancer of rectum  and colon Ulcerative colitis, Crohn’s disease).

Conditions mimicking Hemorrhoids

Hemorrhoids has to be differentiated from the following conditions:

Anal fissure :  

  • A longitudinal tear in anal mucosa
  • Associated with streaks of blood with the passage of stool
  • Highly painful and causes spasm of the anal sphincters  

Anal fistula :

  • An abnormal communication between the anal canal or rectum and skin around the anus 
  •  May cause swelling, pain, discomfort & discharge in perianal region   intermittently

Carcinoma of  rectum :

  • May manifest as painless bleeding per rectum
  •  Tendency to empty the rectum several times a day often with passage of    blood and mucus 
  •  Sudden change in bowel habits, weight loss & anemia are also common

Rectal Prolapse :

  • Refers to protrusion of rectum through anal canal
  •  Common in elderly age group especially among women
  •  Main complaint is “something coming out” during defecation or even during   standing, walking or coughing
  •  Bleeding, mucus discharge and pain are absent

Ano - rectal abscess :

  • An acute, very tender, rounded lump
  •  Can be seen or and felt by the side of anus
  •  Usually accompanied by fever