gastrointestinal disorders
Hemorrhoids
Diagnosis of Hemorrhoids
Anoscopy Sometimes sigmoidoscopy or colonoscopy Most painful hemorrhoids, thrombosed, ulcerated, or not, are seen on inspection of the anus and rectum. Anoscopy is essential in evaluating painless or bleeding hemorrhoids.Rectal bleeding should be attributed to hemorrhoids only after more serious conditions are excluded (ie, by sigmoidoscopy or colonoscopy). Internal hemorrhoids can be classified by grade according to certain features (see table Classification of Internal Hemorrhoids ), which can help guide treatment. Grade Grade Features Features I Prominent hemorrhoids No prolapse II Prolapse after a Valsalva maneuver Prolapse reduces spontaneously III Prolapse after a Valsalva maneuver Prolapse needs manual reduction IV Chronic prolapse Manual reduction of prolapse ineffective Adapted from the American Society of Colon and Rectal Surgeons’2018 clinical practice guidelinesfor the management of hemorrhoids. Exclude other, more serious causes before attributing rectal bleeding to hemorrhoids. 