Fast Five Quiz: Anal Conditions

Richard H. Sinert, DO


March 26, 2021

The most common presentation of hemorrhoids is rectal bleeding, pain, pruritus, or prolapse. Because these symptoms are very nonspecific and may be seen in numerous anorectal diseases, the physician must rely on a thorough history to help narrow the differential diagnosis and must perform an adequate physical examination (including anoscopy when indicated) to confirm the diagnosis. Most symptoms arise from enlarged internal hemorrhoids.

Rectal bleeding is the most common presenting symptom. The blood is usually bright red and may drip or squirt into the toilet bowl, or appear as streaks on the toilet paper. The physician should inquire about the quantity, color, and timing of any rectal bleeding. Darker blood or blood mixed with stool should raise suspicion of a more proximal cause of bleeding.

A patient with a thrombosed external hemorrhoid may present with an acutely painful mass at the rectum. Pain that is truly caused by hemorrhoids usually arises only with acute thrombus formation. This pain peaks at 48-72 hours and begins to decline by the fourth day as the thrombus organizes. New-onset anal pain in the absence of a thrombosed hemorrhoid should prompt investigation for an alternate cause, such as an intersphincteric abscess or anal fissure.

Read more about the presentation of hemorrhoids.


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