How are haemorrhoids diagnosed?
When seeking medical evaluation for suspected hemorrhoids, it is best to book a consultation with a primary care physician or general practitioner (GP).
What to expect at a medical consultation
A medical doctor will open the consultation with a discussion regarding relevant symptoms and note down a person’s medical history. During this process, he or she will ask a series of related questions, which can include:
- When did symptoms first begin?
- Are symptoms fairly mild or highly uncomfortable?
- Has anything seemingly worsened or improved symptoms between the time they began and this consultation?
- What are your typical bowel habits?
- Has a change in bowel habits recently occurred? If so, what?
- Have you noticed the presence of blood following a bowel movement (in the toilet bowl, on toilet tissue paper or in passed stool / faeces)?
- Does your diet contain any fibre? If so, on average, how much would say is included in your daily diet?
- Do you know of any family members who have had hemorrhoids, or cancer of the anus, colon or rectum?
- Do you have any existing medical conditions? If yes, how are these being treated?
- Do you use laxatives or enemas? If so, how often?
A doctor may then request a physical examination. If external (and thrombosed) haemorrhoids are present, these will likely be identified and diagnosed during this time. A doctor will be looking for any signs of swelling, possible lumps, prolapsed haemorrhoids, thrombosed haemorrhoids (external), skin irritation, skin tags, anal fissures, or leakage of mucus or even stool (faeces).
Internal hemorrhoids will need to be assessed via examination tests of the rectum and anal canal.
Tests for this purpose are:
- Digital rectal examination (DRE): This procedure helps a doctor to determine whether it is necessary to conduct further testing. A patient will be requested to wear a medical gown (after removing some clothing) and lay down on their side. Alternative positions a patient can opt for include squatting on an examination table, lying flat on a table with feet in stirrups or bending over a table. The test involves a physical assessment whereby the doctor inserts a gloved and lubricated finger into the rectum to feel for any abnormalities. Should something unusual be felt, such as a growth, he or she will recommend further evaluation and testing (to diagnose or rule out other causes of the symptoms being experienced). Further testing may involve any of those mentioned below. During the test, a doctor will note the tone of muscles in the anus, as well as any possible signs of bleeding or tenderness picked up. He/she can also use the test to obtain a sample of faeces (stool) for a faecal occult blood test, in order to screen for cancer or other causes of gastrointestinal bleeding. This sample will be sent to a laboratory for analysis and results can be ready for discussion within a day or two. The examination is relatively quick and safe, with minor discomfort and can last just a few minutes. A doctor may also apply a little pressure on the lower abdomen during the examination. During the examination, males may feel a little discomfort, the urge to urinate or experience an erection if a little pressure is applied to the prostate, this is completely normal and nothing to feel self-conscious about. A doctor may also check the space between the vagina and anus (rectum) during a female exam for any possible abnormalities. A small amount of bleeding during the examination may occur should there be any haemorrhoids (or anal fissures) present.
- Visual inspection: It can happen that internal haemorrhoids are too soft to be felt and picked up on during a digital rectal exam. Tools such as an anoscope, proctoscope or sigmoidoscope (anoscopy or rigid proctosigmoidoscopy procedures) may be used to examine the lower portion of the rectum and colon (sigmoid) in order to pick up abnormalities (i.e. hemorrhoids). During an anoscopy, using a hollow, lighted tube, a doctor will check the tissue lining of the lower rectum and anus for any signs of bowel disease or lower digestive tract abnormalities. This procedure can be done in a doctor’s office or at an outpatient facility. The procedure does not normally require the use of anaesthetic to be performed safely. A rigid proctosigmoidoscopy is a similar procedure, and for the same purpose, but with a different tool (i.e. a proctoscope). Anaesthetic is also not normally required for this procedure.
- Barium X-ray (or colon X-ray): A doctor may also recommend an X-ray in order to visualise the entire outline of the colon. A person may receive a barium enema (an injection of barium liquid into the rectum via a small tube) when the colon is completely empty. The injected metallic substance lines the colon and helps to create a reasonably clear silhouette of the large intestine for examination. This helps to highlight the presence of any abnormalities during the X-ray, which can then be further analysed or tested for identification. During the test, air may be pumped into the colon (known as air contrast / double contrast) so as to expand the large intestine for a clearer quality image of the lower gastrointestinal tract.
- Colonoscopy: If a doctor feels the entire colon may require detailed examination, a colonoscopy may be recommended. This will be assessed during the consultation and should symptoms hint at a possible digestive system disorder, risk factors for colorectal cancer be high, or a person is middle-aged, then the patient will be referred to a gastroenterologist. A flexible sigmoidoscopy is an alternative procedure to a colonoscopy which can also be recommended.
- Blood tests: A doctor may recommend a sample of blood be taken should any excessive bleeding have occurred. Blood tests may be recommended so that a person’s red blood cell count (haemoglobin) can be checked. If it comes to light that any blood thinning medications have been taken, a blood sample may help to determine whether any abnormalities have taken place as a result (i.e. abnormal blood thinning).