Hemorrhoids (cont.)
How are hemorrhoids diagnosed?
Most individuals who have hemorrhoids discover them in one of several ways. They
either feel the lump of an external hemorrhoid when they wipe themselves after a
bowel movement, note drops of blood in the toilet bowl or on the toilet paper,
or feel a prolapsing hemorrhoid (protruding from the anus) after bowel
movements. Severe anal pain may occur when an external hemorrhoid thromboses, or
a prolapsing internal hemorrhoid becomes gangrenous. Symptoms of anal discomfort
and itching may occur, but anal conditions other than hemorrhoids are more
likely to cause these symptoms than hemorrhoids. (Hemorrhoids often get a "bum
rap" for such symptoms since both hemorrhoids and other anal conditions are
common and may occur together. For example, up to 20% of individuals with
hemorrhoids also have anal fissures.)
By the history of symptoms, the physician can suspect that hemorrhoids are
present. Although the physician should try his or her best to identify the
hemorrhoids, it is perhaps more important to exclude other causes of
hemorrhoid-like symptoms that require different treatment. These other
causes - anal fissures, fistulae, perianal (around the anus) skin diseases,
infections, and tumors - can be diagnosed on the basis of a careful examination
of the anus and anal canal. If necessary, scrapings of the anus to diagnose
infections and biopsies of the perianal skin to diagnose skin diseases can be
done.
External hemorrhoids appear as a bump and/or dark area surrounding the anus. If
the lump is tender, it suggests that the hemorrhoid is thrombosed. Any lump
needs to be carefully followed, however, and should not be assumed to be a
hemorrhoid since there are rare cancers of the perianal area that may masquerade
as external hemorrhoids.
The diagnosis of an internal hemorrhoid is easy if the
hemorrhoid protrudes from the anus. Although a rectal examination with a gloved
finger may uncover an internal hemorrhoid high in the anal canal, the rectal
examination is more helpful in excluding rare cancers that begin in the anal
canal and adjacent rectum. A more thorough examination for internal hemorrhoids
is done visually using an anoscope. An anoscope is a three-inch long, tapering,
metal or clear plastic hollow tube approximately one inch in diameter at its
viewing end. The anoscope is lubricated and inserted into the anus, through the
anal canal, and into the rectum. As the anoscope is withdrawn, the area of the
internal hemorrhoid(s) is well seen. Straining by the patient, as if they are having a
bowel movement, may make the hemorrhoid(s) more prominent. Anoscopy also is a good
way for diagnosing anal fissures.
At times, indirect anoscopy may be helpful. Indirect
anoscopy uses a special mirror for visualizing a patient's anus while the
patient is seated and straining on a toilet. Indirect anoscopy allows the doctor
to see the effects of gravity and straining on the anus. For example, the
physician may be able to determine if what is prolapsing is a hemorrhoid, rectal
lining, a rectal polyp,
or the rectum itself (a condition called procidentia in which the rectum turns
inside out and protrudes from the anus).
Whether or not hemorrhoids are found, if there has been bleeding, the colon above the rectum needs to be
examined to exclude important causes of bleeding other than hemorrhoids. Other
causes include, for example, colon cancer,
polyps,
and colitis (inflammation of the rectum
and/or colon). This examination can be accomplished by either
flexible
sigmoidoscopy or colonoscopy, procedures that
allow the doctor to examine approximately one-third or the entire colon,
respectively.
Next: How are hemorrhoids treated? »
- hydrocortisone-rectal suppository, Anucort-HC, Anusol-HC, Cort-Dome - Consumer information about the medication HYDROCORTISONE - RECTAL SUPPOSITORY (Anucort-HC, Anusol-HC, Cort-Dome), includes side effects, drug interactions, recommended dosages, and storage information. Read more about the prescription drug HYDROCORTISONE - RECTAL SUPPOSITORY.
- Colonoscopy - Learn about the colonscopy procedure, what it is, why it is performed, preparation, complications, alternatives and the after effects of the screening exam on MedicineNet.com
- Rectal Bleeding - Rectal bleeding can be a sign of several different conditions including hemorrhoids, anal fisure, colitis, and more.
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