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Piles (Haemorrhoids)

Updated 08 August 2018

Diagnosis of haemorrhoids

Learn more about how haemorrhoids - a very common problem - gets diagnosed.

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To determine if you have haemorrhoids, your doctor will ask about your medical history and the symptoms you’re experiencing. He or she will then do a physical examination to establish the extent of your haemorrhoids.

Your doctor will ask you to lie on your side, with your knees pulled up towards your stomach.

First, he or she will just examine the outside of your anus to check for any external piles, signs of thrombosed piles, and signs of infection.

If your haemorrhoids aren’t visible externally, your doctor will also do a digital examination. During this examination, he or she will place a gloved, lubricated finger in your anus to feel for any haemorrhoids and masses.

Your doctor will also check for any bleeding. An internal examination may be slightly uncomfortable, but should never be painful. 

Other tests and examinations include:

  • Proctoscopy: This is performed to identify internal haemorrhoids. The proctoscope has a light at the end, which helps your doctor to see the anus, anus canal and lower rectum.
  • Flexible sigmoidoscopy: This scope has a camera at the end that makes the area visible on a computer screen. This examination can rule out the presence of cancer, diverticular disease and inflammatory bowel disease (IBD).

Differential diagnosis
The symptoms of haemorrhoids overlap with those of many other conditions. It’s therefore important for your doctor to exclude the possibility of:

  • Anal fissures – small tears in the thin, moist tissue that lines the anus.
  • Rectal prolapse – when part or all of the wall of the rectum slides out of place.
  • Abscesses and fistulas – when a gland in the anus becomes infected, and small tunnels form between the gland and the skin on the outside of the anus.
  • Inflammatory bowel disease – this includes Crohn’s disease and ulcerative colitis.
  • Neoplasia – new, abnormal growth of tissue, which could indicate cancer.

Seek emergency care if you experience large amounts of rectal bleeding, light-headedness, dizziness, or faintness.

Reviewed by Dr Britta Dedekind, General Surgeon at Christiaan Barnard Memorial Hospital. MBChB, FCS (SA), MMED (UCT). April 2018.