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Examining For Hemorrhoids

In order to detect if a person has hemorrhoids, most colon and rectal surgeons use physical examination. Many patients with anal complaints, however, dread the going through this procedure. Often, they experience repeated rectal examination and anoscopies from inexperienced examiners. Thus, it is important to suppress the fears of these patients before going to performing any examination if any meaning is to be acquired.

For the examination, you’re going to lie in the left lateral Sims or decubitus position. This is more comfortable, and is usually less humiliating and easier to hold than the lithotomy or prone jackknife positions. It’s important to know that you are going to need to lie such that the examiner is going to get a good view of the anal area.

So that the examination itself is as easy as possible, you’re probably going to be placed lying on your belly more than on your back, positioned with your buttocks a little bit off the edge of the examining table, left side down, right shoulder rolled forward and left shoulder back. Your knees are going to be bent up towards your chest and your feet clear of the anal area.

This ensures that the anal area is going to be exposed enough to be examined without as much discomfort for the person being examined. The examiner will gently spread the buttocks apart and include the external perineal area for any eczematous lesions, abnormal findings or rashes. Usually, the examiner will ask the patient to contract the external sphincter to make sure there are no abnormalities in function.

After this, you’re going to be asked to bear down like you were having a bowel movement, and as you do this, the examiner will gently insert a lubricated figure into the anus, also called a digital examination. This should only take a couple of minutes, and typically will not hurt, although it will be uncomfortable.

And anoscopy will be performed after the digital examination is finished. This is to officially confirm that you do have hemorrhoids as the patient by using an anoscope, which is a hollow to with a light at one end, subsequently attached to a viewing machine. The anoscope that does a side view is preferred to one that does only an end view because side view anoscopes look at the anal canal and the rectum, not just the rectum.

Upon insertion, the viewing anoscope should be positioned with the open portion in the right anterior followed by the right posterior and lastly the left lateral position to observe for hemorrhoidal bundles. As the rectal surgeon examines, a pathologist will also observe for signs of dilated vascular spaces that may inhibit thrombosis and recanalization.

In some cases, you may also be required to undergo a colonoscopy or sigmoidoscopy if the examiner needs more detail. If any prolapses have occurred with hemorrhoids, you may be requested to again bear down or strain after the procedure is complete. Anal outlet bleeding does happen with hemorrhoids but it can also be a sign of colorectal cancer, which is a concern. Therefore, if you have rectal bleeding, you will need to be examined further to make sure only hemorrhoids and no other diseases are present.

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