Fast Five Quiz: Hemorrhoids Practice Essentials

B.S. Anand, MD

Disclosures

April 18, 2022

Pain 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. However, pain from distention of the overlying skin by the blood clot may last 5-12 days. 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.

The most common presentation of hemorrhoids is rectal bleeding, pain, pruritus, or prolapse. Because these symptoms are extremely nonspecific and may be seen in numerous anorectal diseases, the physician must therefore 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.

Internal hemorrhoids are often painless. External, thrombosed hemorrhoids are more likely to be associated with pain. External hemorrhoids occur more commonly in younger and middle-aged adults than in older adults.

Digital examination of the anal canal can identify any indurated or ulcerated areas. It also allows assessment for masses, tenderness, mucoid discharge or blood, and rectal tone. Because internal hemorrhoids are soft vascular structures, they are usually not palpable unless thrombosed.

Learn about the clinical presentation of hemorrhoids.

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