Hemorrhoid Diagnosis: What to Expect

You suspect that you have hemorrhoids but you want to make sure; consultation with a colorectal surgeon is imperative. But then questions would arise: “How would the doctor do it?” “Isn’t it embarrassing?” “It won’t be painful right?” The answers to these questions are not only important in easing your emotions but also in shedding light to what really entails the diagnosis of hemorrhoids.

Diagnostic Sequences for Hemorrhoids (For New Patients)

1. Upon entering the clinic, a nurse will ask you to fill a questionnaire on details of your symptoms. This serves as a preliminary interview. Other doctors may just interview you directly before or after the examination. Also, be ready to present your medical history as this will be pertinent to the diagnosis. The questions in the interview will be in the lines of: “Were you bleeding? If so, for how long and is it minimal or excessive?” “Describe the blood’s color.” “What are the symptoms that you are experiencing and for how long had it been happening?” “Do you have any history of colorectal disease?”

2. The nurse will then instruct you on your part in the examination, including adopting the proper examination posture.

Hemorrhoid Examination Positions

• Left Lateral Position

This is also called Sim’s Position. Over 70% of colorectal surgeons (practitioners in the field of proctology or the field of practice involving the anus and rectum) favor this position. You are made to lie on your left side with your knees joined and flexed so that the hips, especially the buttocks will stick out for easier examination. Some would place a pillow under the buttocks for convenience.

• Lithotomy Position

In Japan, colorectal surgeons prefer to use this position for male patients. You are made to lie on your back with pillows placed under your head and hips. The knees are pulled up by both hands, to stay in place as the proctologist go on with the examination.

• Knee-Chest Position

You go down on your knees and elbows, with your head resting on a pillow and your chest almost level with your head. Your back should be angled so that your buttocks will stick out.

 

3. If you feel uncomfortable with these positions and worries about modesty, don’t worry, the nurse will cover exposed parts of your body with a blanket. In some hospitals, there is a curtain that would cover the lower part of your body so that when someone comes in, you won’t be exposed.

4. The colorectal surgeon will then examine your anus. He will undergo some simple tests that are minimally invasive. This is the main diagnostic test for hemorrhoids. Some of these tests are:

Digital Rectal Examination (DRE)

The colorectal surgeon uses his gloved index finger to inspect from the anus to the rectum. The glove is usually lubricated with hemorrhoid ointments or lidocaine jelly that has anesthetic effects (make sure to state if you have any allergic reaction to lidocaine). The anus is massaged before insertion and the colorectal surgeon would often inform you when the insertion will take place.

The examination is done in three steps:

1. The fingertip is used to check from the anal verge to the dentate line (the colorectal surgeon can also use his thumb to palpate the anus). This is to check the tone of the internal sphincter, the presence of external hemorrhoids, anal cancer and anal fistula tract. This is also important for the differential diagnosis of anal fissure and perianal abscess.
2. The finger is further inserted up until the middle joint. All sides would be palpated, to determine the size of the hemorrhoid and the degree of the prolapse and the fistula if there is any present.
3. The full length of the index finger will now be inserted. At this step, rectal cancer can be detected. Other adjacent organs can also be examined, including the prostate and cervix.

 

Anoscopy

An anoscope (also called anal speculum) can be used to examine the internal structure of the anal canal. This can be useful in differentiating one condition from the other. There are three types of anoscopes, the cylindrical, specular and ladle type. The latter is seldom used. The cylindrical anoscope is used by inserting its length in the anal canal while the specular anoscope is used by inserting and then opening it sideways.

Sigmoidoscopy

Though colonoscopy is much favored, sigmoidoscopy is practical especially in quick diagnostic examinations. The sigmoidoscope only examines until the sigmoid (as it was named) while the colonoscopy examines the entire colon. There are two types of sigmoidoscopy, the rigid and the flexible. The flexible is the preferred type as the rigid sigmoidoscopy can cause considerable pain during examination.

Colonoscopy

Colonoscopic examination may not be necessary for hemorrhoids especially if the previous examinations had positively identified the condition as hemorrhoids. Colonoscopy is of great importance not only in diagnosing hemorrhoids but also in detecting if there is any other disease present.

A fiber optic camera is mounted on a flexible tube that will be inserted in the anus. This camera is used for visual diagnosis. Colonoscopy can also remove polyps for biopsy. This will be done under sedation and if the doctor indeed asks for a colonoscopy, it can’t be done on the same day as your consultation as the colon must be cleansed first.

5. The colorectal surgeon will then explain his findings, state if further examinations will be needed and explain the course of any hemorrhoid treatments. If surgery and hospitalization is necessary, the colorectal surgeon will outline the necessary procedures to be done.