How is the diagnosis made?
Hemorrhoids are a clinical diagnosis.
Describe the anoscopy.
Insertion of an anoscope to directly visualize the anus and distal rectum
Perform in all patients with suspected hemorrhoids.
May show hemorrhoids or differential diagnoses, e.g., anal carcinoma or fissure
List DDs.
Anal skin tags: benign, painless folds of skin at the anal verge that are residues of previous episodes of inflammation or thrombosed hemorrhoids [5]
Hypertrophied anal papillae
Polyps
Anal and colorectal carcinoma
Anal fissures (cause painful bright red bleeding per rectum)
Anorectal varices
Proctitis
Condyloma acuminata
Inflammatory bowel disease (often associated with anal fistulas and abscesses)
Rectal prolapse
Perianal dermatitis
Always consider the possibility of concurrent colorectal carcinoma!
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