Methods for the diagnosis of hemorrhoids

, medical expert
Last reviewed: 23.04.2024

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When a doctor examines a patient, his hemorrhoids (bumps) are visible to the naked eye. They are as small as peas, or as large as cherries. Cones can be single or they can be a whole wreath. But hemorrhoids can be not only external, but also internal. How to diagnose hemorrhoids if the lumps are not visible?

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When is hemorrhoids diagnosed?

Most people who suffer from hemorrhoids, detect it when the effects have already gone far, for example, blood is flowing from the anus. Or people start to worry. When they notice remnants of blood, when they wipe off after a bowel movement.

Severe anal pain can occur when external hemorrhoids manifest themselves as thromboses, or the prolapse of internal hemorrhoids becomes gangrenous.

But it is worth knowing that the symptoms of anal itching and burning may also occur with other diseases, and not only with hemorrhoids. For example, up to 20% of people with hemorrhoids also suffer from anal fissures.

After studying the history of symptoms, the doctor may suspect that there is no hemorrhoids, but there is another disease with similar symptoms. Although the doctor must palpate it to make sure the diagnosis and better determine the hemorrhoids. The disease can be diagnosed based on a thorough examination of the anus and anal canal. If necessary, the doctor will take scrapings from the anus to diagnose the infection and perform a biopsy of the perianal skin to diagnose skin diseases.

Questions of the doctor

To make an accurate diagnosis of hemorrhoids, a doctor can start with a number of questions. These questions will be such

  1. What are the symptoms?
  2. Does the patient have constipation or diarrhea?
  3. Any medications you take?
  4. Any recent injury?
  5. Sexual practices?

When diagnosing hemorrhoids, a survey is usually the most important part of visiting a doctor. During a medical examination, your doctor will look for signs of hemorrhoids. He will also do a rectal exam to determine common causes of rectal bleeding.

If your doctor is still not sure whether hemorrhoids are or the symptoms of another disease, he may recommend anoscopy, proctoscopy or rectoromanoscopy. These tests allow the doctor to directly see the condition inside the anus and rectum.

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Palpation method

Doctors carry out this method for any diseases that relate to the state of the rectum. The method of palpation is a very important method in the diagnosis of hemorrhoids and other diseases of proctological nature. A study by palpation allows the doctor, without using expensive instruments, to form an opinion about the health status of the colon and rectum. In addition to the method of palpation, there are a number of methods that diagnose hemorrhoids. First of all, these are laboratory research methods - koproskopiya, anoscopy, proctoscopy.

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Rectoromanoscopy (or sigmoscopy)

This method explores the rectum and lower portion of the nearby sigmoid colon. The mucous membrane that covers the inner walls of the rectum, with this examination is visible in length up to 35 cm

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How retromanoscopy is performed

You will be asked to lie on your left side, knees to chest. A gastroenterologist or surgeon will usually perform a tolerance test. The doctor gently places a finger in the glove and smeared with an anesthetic gel or petroleum jelly in the rectum to check for blockage and gently increase (widen) the anus. This is called digital rectal examination.

Next, a flexible tube, called a sigmoidoscope, is inserted through the anus and gently moves into the rectum. This tool has a small camera connected to its end. The tube with air is placed in the large intestine to open its area and help the doctor see better (air is pumped into the large intestine to smooth its folds). Air may cause the urge to stool or gas. Suction through the tube can be used to remove fluid or stools from the rectum and colon.

Tissue samples can be taken with a tiny biopsy tool, small tweezers are inserted through the rectum area. Polyps can be removed by electrocautery directly during the examination - that is the particular benefit of retromanoscopy. Images of the rectum and colon enter the screen, where the doctor can see all the changes in these organs.

Rectoromanoscopy can be used to treat problems of the anus or rectum.

How to prepare for the procedure

Your doctor or nurse will tell you how to prepare for the procedure. Preparation includes the prior use of enemas to clean the intestines. It takes about 1 hour before sigmoidoscopy is performed.

In the morning before the procedure is allowed to eat a light breakfast.


How will you feel

During the procedure, you can feel

  • A little uncomfortable when the tube or fingers are in the rectum
  • You want to use the toilet
  • There may be symptoms of bloating or cramps caused by air or a bowel movement with a sigmoscope, but this does not hurt.

After the procedure, the air that was injected from your intestinal tract can be pumped out. Children may not undergo these procedures.

Why retromanoscopy is performed

This procedure may help diagnose the cause.

  • Stomach ache
  • Diarrhea, constipation and other changes in the intestines
  • Blood, mucus, pus or in the stool
  • Weight loss

This procedure can be used to

  • Confirm another test or fluoroscopy
  • Examine the rectum and colon for colorectal cancer or polyps
  • For biopsy of tumor growth

Normal results

Normal results show that the mucous membrane of the sigmoid colon, the mucous membrane of the rectum and anus of normal color, texture and size.


Bad results may indicate

  1. Anal fissures
  2. Anorectal abscess
  3. Intestinal obstruction
  4. Crayfish
  5. Polyps
  6. Diverticulosis (abnormal sacs on the intestinal mucosa)
  7. Hemorrhoids
  8. Hirschsprung's disease (blockage of the colon due to abnormal movement of the muscles of the intestine is a congenital condition)
  9. Inflammatory bowel disease
  10. Inflammation or infection (proctitis)


There is a small risk of intestinal perforation (opening a hole) and bleeding at the biopsy sites (the total risk is less than 1 per 1000).

Alternative procedure names

Flexible sigmoidoscopy; proctoscopy; rectoromanoscopy; hard sigmoidoscopy, sigmoscopy

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This is the method by which the anal canal, the anus and the lower part of the rectum are examined. It uses a special device - anoscope. With it, you can track the state of the rectum and anal canal at a distance of 10 to 12 centimeters, starting from the anus to the depths.

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How is the procedure

This procedure is usually performed in the doctor’s office.

Digital rectal research is done first. Then lubricate the instrument (anoscope) with gel or petroleum jelly and place it a few centimeters into the rectum. You will feel some discomfort.

Anoscope has LEDs at the end, so that the doctor will be able to see the entire anal canal. If necessary, tissue samples can be taken for biopsy - this is a very good procedure.

How to prepare for the procedure

You can get laxatives, enemas, or do another preparation before the procedure, your main task is to completely empty the bowels. Before the procedure, you should also empty your bladder.

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How will you feel during the procedure

There will be some discomfort during the procedure and you may feel the need to have a bowel movement. You may not feel very comfortable when you have a biopsy. But you can return to normal activities right after the procedure.

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Why anoscopy is performed

It can be used to identify diseases.

  1. Anal fissures
  2. Anal polyps
  3. Hemorrhoids
  4. Infections
  5. Inflammation
  6. Tumors

Normal results

The anal canal is normal in size, color and tone. It has no bleeding, polyps, hemorrhoids, or abnormal tissue.

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What do bad results mean

  1. Abscess
  2. Cracks
  3. Hemorrhoids
  4. Infection
  5. Inflammation
  6. Polyps (non-cancerous or malignant)
  7. Tumors


If a biopsy is still necessary, there is a small risk of bleeding and moderate pain.



Colonoscopy examines the mucous membrane of the gastrointestinal tract, in particular the colon. Doctors examine it with the help of a special device - an endoscope. It consists of LEDs that look like a flexible hose. They transfer the image of the colon to a computer screen.

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How to prepare for colonoscopy

The doctor usually gives written or oral instructions on how to prepare for a colonoscopy. This process is called intestinal preparation. As a rule, all solids must be removed from the gastrointestinal tract. And you need to follow a liquid diet from 1 to 3 days before the procedure. Patients should not drink beverages containing a red or purple dye. The list of liquids includes

  • low fat broth
  • fruit juice mixes
  • water
  • coffee
  • tea

On the eve of a colonoscopy, a laxative or enema may be required. Laxative drink in order to loosen the stool and increase bowel movements. Laxatives are usually absorbed in the form of tablets or in the form of a powder dissolved in water. Enemas are performed by washing with water and sometimes with a mild soap solution; they are inserted into the anus using a special tube.

Patients should inform the doctor about all the medical circumstances in which you are staying: do you drink medicine, take vitamins or supplements, including

  • aspirin
  • arthritis medications
  • blood thinners
  • diabetes medications
  • vitamins that contain iron

Driving is not allowed within 24 hours after a colonoscopy. Before prescribing, patients should make plans for a trip home not at the wheel, but at the passenger's seat.

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Colon during examination

During a colonoscopy, patients lie on their left side. In most cases, mild sedation and, possibly, pain medication, helps patients to relive the procedure more easily. Local anesthesia may be required in rare cases. The doctor and the medical staff monitor vital functions and try to make the patient's position as comfortable as possible.

The doctor inserts into the anus a long flexible illuminated tube, called a colonoscope, and slowly sends it through the rectum to the large intestine. The volume of air enters the colon through the hose to allow the doctor to better see the condition of the colon. A small camera mounted on the device transmits the video image from the inside of the colon to the computer screen, which allows the doctor to carefully examine the condition of the intestinal mucosa. The doctor may ask the patient to move periodically, so that the screen can be adjusted for better viewing.

After the tube has reached the small intestine, it is slowly removed and the mucous membrane of the large intestine is carefully studied again. As a complication of colonoscopy, bleeding and puncture of the colon are possible, but this is rare.


Polyp removal and biopsy

A doctor can remove growths, called polyps, right during a colonoscopy, and then test them in the laboratory for signs of cancer. Polyps are frequent in adults and are generally harmless. However, most tumors of colorectal cancer begin as a polyp, so the removal of polyps in the early stages is an effective way to prevent cancer.

During a colonoscopy, the doctor may also take samples of abnormal tissue. The procedure, called a biopsy, allows the doctor to look at these tissues under a microscope later and check for signs of illness.

The doctor removes polyps and takes a biopsy of the tissue with tiny instruments. If bleeding occurs, the doctor will stop it with an electric probe or special medication. Removal of the affected tissue and treatment to stop bleeding is usually painless.

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Recovery after colonoscopy

Colonoscopy usually takes from 30 to 60 minutes. Spasms or bloating may occur during the first hour after the procedure. It takes time to completely deal with these symptoms. Patients may have to stay in the clinic for 1 to 2 hours after the procedure. Full recovery is expected the next day. A number of medical instructions must be carefully read and followed. Patients who experience any of these rare side effects should see a doctor if symptoms occur.

  • severe abdominal pain
  • fever
  • bloody feces
  • dizziness
  • weakness

At what age should a colonoscopy be performed?

Regular colonoscopy, in order to detect early signs of cancer, should begin at the age of 50 years, and for most people earlier, if they have heredity in a disease of colorectal cancer, a personal medical history of inflammatory bowel disease or other risk factors. The doctor may advise patients on how often a colonoscopy should be performed.


What is a virtual colonoscopy?

Virtual colonoscopy is a procedure used to search for signs of pre-cancerous growths called polyps, as well as cancer and other colon diseases. The fundamental difference between the virtual colonoscopy and the traditional one is in the use of modern radiological methods of examination - CT and MRI. Images of the colon are done using computed tomography (CT) or, less commonly, magnetic resonance imaging (MRI). A computer combines images together to create an animated, three-dimensional view of the inside of the colon.

Intestinal preparation

The preparation of the intestine for virtual colonoscopy is almost identical to the preparation of the intestine for conventional colonoscopy. As a rule, all solids must be removed from the gastrointestinal tract (GIT), and the patient must also be on a liquid diet 1 to 3 days before the procedure.

A laxative is taken on the night before a virtual colonoscopy. A laxative is used to loosen the stool and increase the number and volume of bowel movements. Laxatives are usually offered to the patient in the form of tablets or in the form of a powder dissolved in water.

After preparing the intestines, patients undergoing virtual colonoscopy drink a liquid called a contrast agent. It shows very bright images of changes in the colon at CT. The contrast agent helps the physician identify changes in the tissues.

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How is virtual colonoscopy performed?

A virtual colonoscopy is performed at the radiology department at a hospital or medical center, where the CT scanner or MRI scanner is located. The procedure takes about 10 minutes and does not require anesthetic.


How is the virtual colonoscopy procedure?

The patient lies face up on the table. A thin tube is inserted through the anus and is advanced into the rectum. Further, for better viewing of the colon, air will be pumped, it will cause the colon to expand. When performing an MRI, contrast agents are applied rectally after the colon has been dilated.

The image will move through a CT or MRI scanner to produce a series of cross-sectional images of the colon.

At various points during the procedure, the doctor may ask the patient to hold his breath in order to stabilize the image. The procedure will be repeated, but only this time the patient will lie face down.

After the procedure, cross-sectional images taken with CT or MRI are processed to create three-dimensional images of computer-generated images of the colon. A radiologist assesses the results to identify anomalies. If irregularities are found, normal colonoscopy can be performed on the same day or at a later time.

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How does a virtual colonoscopy differ from a conventional colonoscopy?

The main difference between virtual and conventional colonoscopy is what the doctor sees inside the colon. A conventional colonoscopy uses a long, lighted flexible tube, called a colonoscope, to see everything inside the colon, while a virtual colonoscopy uses CT or MRI.


What are the benefits of virtual colonoscopy?

  1. Virtual colonoscopy has several advantages compared with other procedures:
  2. Virtual colonoscopy does not require inclusion in the colonoscope along the entire length of the colon. Instead, a thin tube is inserted through the anus and rectum, expanding it with air.
  3. Time to recover, like painkillers, is not required. The patient can return to normal activities or go home after the procedure without the help of another person.
  4. Virtual colonoscopy provides clearer, more detailed images than conventional X-rays using barium enema.
  5. Virtual colonoscopy takes less time than regular colonoscopy.
  6. A virtual colonoscopy will help the doctor see everything inside the colon, which narrows due to inflammation or the presence of abnormal tissue growth.

What are the disadvantages of virtual colonoscopy?

Virtual colonoscopy has several disadvantages.

  1. As with conventional colonoscopy, virtual colonoscopy requires the preparation of the intestine and the introduction of the tube into the rectum to expand the colon with air or liquid.
  2. Virtual colonoscopy does not allow the doctor to take tissue samples or remove polyps.
  3. Virtual colonoscopy cannot detect precancerous polyps less than 10 millimeters.
  4. Virtual colonoscopy is a new technology and is not as widely available as conventional colonoscopy.


An irrigoscopy is an X-ray examination of the colon. Before this, it is necessary to conduct a koproskopiya, that is, an analysis of feces. Its composition, shape, quantity, color, the presence of foreign bodies, residues of mucus and pieces of food that has not been digested are analyzed. Another analysis of feces for occult blood, the color of feces may indicate this - tar or with the inclusion of red.

This analysis is done in order to check whether there is no bleeding in the intestines - in all its parts. And in addition to this method, the doctor usually recommends donating blood for analysis to determine if the patient is anemic.

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Which doctor to contact?

It may be:

  • Proctologist
  • Surgeon
  • Oncologist
  • Gastroenterologist

To visit the clinic you need to prepare and also be ready to answer all the questions of the doctor. Only he will be able to determine if you have hemorrhoids or this is another disease with similar symptoms.

Is it really a hemorrhoid or other disease?

Hemorrhoids are the most common source of rectal and anus bleeding. However, there are a number of conditions that affect the anus or rectum, and have similar symptoms. Here are some of them

  • Anal fissure
  • Anal fistula
  • Rectal abscess
  • Irritation and itching caused by excessive moisture, diabetes or liver failure
  • Coccyx infection

In older people, colorectal or colon cancer is the most important cause of rectal bleeding. Therefore, if the bleeding lasts more than a few days, it is very important that you visit a doctor. He can diagnose your problem and recommend treatment.


Additional examinations

They can be prescribed for women to rule out any other medical conditions.

For example, women should have a detailed examination by a gynecologist to rule out diseases associated with gynecological problems. An examination of women may include an examination:

  • Life
  • Breast
  • Crotch
  • Anus
  • Vagina

This will eliminate the risk of misdiagnosis in genital diseases, including tumors.


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