Fast Five Quiz: Hemorrhoids Practice Essentials

B.S. Anand, MD


April 18, 2022

To evaluate any bright-red rectal bleeding, most gastrointestinal and surgical societies advocate anoscopy and/or flexible sigmoidoscopy. Physicians should consider colonoscopy to evaluate rectal bleeding that is not typical of hemorrhoids, such as following up on rectal bleeding after a negative anorectal examination or in the presence of strong colon cancer risk factors.

In patients who are suspected of having complicated hemorrhoids, the World Society of Emergency Surgery and American Association for the Surgery of Trauma (WSES-AAST) guidelines suggest imaging investigation (CT, MRI, or endoanal ultrasonography) only if there is suspicion of concomitant anorectal diseases (sepsis/abscess, inflammatory bowel disease, neoplasm).

Routine histologic examination of hemorrhoidal tissue is usually unrewarding. However, 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.

Proctoscopy may be performed to supplement anoscopy. Anoscopy is mandatory 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.

Learn more about hemorrhoids workup.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.