Fast Five Quiz: Hemorrhoid Diagnosis and Treatment

Praveen K. Roy, MD

Disclosures

March 07, 2019

Anoscopy is indicated for viewing internal hemorrhoids. The anoscope should be a side-viewing one. When angled well by the examiner, the side-viewing anoscope allows the soft hemorrhoidal tufts to fill the beveled end of the scope and to be appropriately evaluated. Prolapse can be observed when the patient performs a Valsalva maneuver. Proctoscopy may be performed to supplement anoscopy, and proctography may be indicated in rectal prolapse.

Routine histologic examination of hemorrhoidal tissue is usually unrewarding, especially if it is grossly examined by an experienced anorectal surgeon. Any suspicious tissue must be sent for microscopic evaluation. External hemorrhoids are classified by the underlying pathology and symptoms, which include thrombosed veins, bleeding from eroded blood clots, and skin tags causing hygiene problems.

A complete blood cell count may be useful as a marker for infection. Anemia due to hemorrhoidal bleeding is possible, albeit rare (0.5 case per 100,000 patients), and its presence should raise suspicion of an alternate diagnosis. Hematocrit testing is suggested if excessive bleeding with concomitant anemia is suspected.

Read more on the workup of hemorrhoids.

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