Diagnosing Hemorrhoids

To diagnose hemorrhoids, your doctor will rule out other problems and determine how bad your hemorrhoids are. After the evaluation, your doctor will help you decide on a treatment plan that’s best for you.

Medical History

A medical history helps your doctor learn more about your symptoms and overall health. This often includes questions about your bowel habits and diet. You may also be asked how often you exercise and whether you take any medications. Be sure to mention if any members of your family have had cancer or polyps of the colon.

Man lying on side on exam table. Two healthcare providers are standing by table.

Physical Exam

During a physical exam, you’ll be asked to lie on an exam table. You’ll then be examined for signs of swollen hemorrhoids and other problems. The exam takes just a few minutes. It is usually not painful.

  • A visual exam is used to view the outer anal skin.

  • A digital rectal exam is used to check for hemorrhoids or other problems in the anal canal. It is done using a lubricated gloved finger.

  • An anoscopic exam is done using a special viewing tube called an anoscope. The scope helps your doctor view the anal canal.

Grading Hemorrhoids

Based on the physical exam, your doctor may assign a grade to internal hemorrhoids. The grades are based on the severity of your symptoms.

  • Grade I hemorrhoids do not protrude from the anus. They may bleed, but otherwise cause few symptoms.

  • Grade II hemorrhoids protrude from the anus during bowel movements. They reduce back into the anal canal when straining stops.

  • Grade III hemorrhoids protrude on their own or with straining. They do not reduce by themselves, but can be pushed back into place.

  • Grade IV hemorrhoids protrude and cannot be reduced at all. They can also be painful and may require prompt treatment.

Pregnancy and Hemorrhoids

Many women develop hemorrhoids during pregnancy and childbirth. This is likely caused by pressure on the pelvis and by hormonal changes. In most cases, the hemorrhoids will eventually go away on their own. In the meantime, talk with your doctor about ways to help relieve your symptoms.


Other Anal Problems

Below are common problems that can cause symptoms similar to hemorrhoids. Your doctor can explain your treatment options.

  • A fissure is a small tear or crack in the lining of the anus. It can be caused by hard bowel movements, diarrhea, or inflammation in the rectal area. Fissures can bleed and cause painful bowel movements.

  • An abscess is an infected gland in the anal canal. The infected area swells and often causes pain.

  • A fistula is a pathway that may form when an anal abscess drains. The pathway may remain after the abscess is gone. Fistulas are not usually painful. But they can cause drainage where the pathway meets the skin.