Hemorrhoids Đánh giá ban đầu

Cập nhật: 04 November 2025
Được đánh giá bởi

Clinical Presentation

Symptoms of hemorrhoids include rectal bleeding which is the most common presenting symptom and bright red blood which may drip or squirt into the toilet bowl or scanty amounts may be seen on toilet tissue; discomfort due to rectal protrusion or lump; anal pain or pain during defecation; anal itching; burning sensation; and swelling near the anus.

Tiền sử bệnh

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Assess the following: The nature, extent, duration and severity of symptoms; the amount and frequency of bleeding; the presence of prolapsing tissue, its timing and reproducibility; the presence or absence of perianal pain; and concerns with perineal hygiene. Elicit possible risk factors for the development of hemorrhoidal symptoms such as pregnancy, advanced age, and a history of chronic cough, constipation, diarrhea, heavy lifting, and inadequate water intake. Low-fiber diets may cause small-caliber stools, resulting in straining during defecation and engorgement of hemorrhoids. Prolonged sitting on a toilet may also cause a problem in the venous return in the perianal area.

The signs and symptoms of hemorrhoids are not specific to the disease, so care must be taken to avoid missing other causes of pathology. Previous treatments or therapeutic interventions should also be reviewed. Obtain a good family medical history to assess the possibility of familial colorectal neoplastic syndromes, which may indicate a need for a more detailed colonic evaluation.

Khám thực thể

Examine for evidence of liver disease, chronic obstructive pulmonary disease (COPD), and constipation (eg abdominal distention or fecal impaction). Perform a careful anorectal evaluation. Inspect the entire perianal area at rest and while straining. Reassure the patient and warn him or her before doing any maneuvers. Gently spread the buttocks to visualize the anoderm and the distal anal canal. Examine for hemorrhoids and their possible complications (eg skin tags, prolapsing internal hemorrhoids, thrombosed external hemorrhoids, incarcerated prolapse of the rectal mucosa). If hemorrhoids are present, differentiate between external and internal hemorrhoids. Inspect the area for other lesions (eg fissures, perianal dermatitis or perineal excoriation, abscess, fistula, neoplasms, condylomata). Palpation of the perineum is performed to evaluate the presence of masses, areas of induration or tenderness. Perform a digital rectal exam. This may be able to identify areas of induration or ulceration and assess sphincter tone, abscesses, masses and pain.

Anoscopy



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Anoscopy is recommended to establish the diagnosis of hemorrhoids and to exclude other anal canal pathology. It is compulsory for evaluating internal hemorrhoids. Instruct the patient to do a Valsalva maneuver to assess the degree of prolapse. 

Screening

Grading of Internal Hemorrhoids



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Internal hemorrhoids are classified based on the severity of symptoms they cause:

  • Grade I: Prominent hemorrhoidal vessels that usually bleed, no prolapse
  • Grade II: Prolapse with Valsalva maneuver or straining but reduces spontaneously
  • Grade III: Prolapse with Valsalva maneuver or straining and requiring manual reduction
  • Grade IV: Permanently prolapsed and manual reduction is not effective. These usually have both internal and external components and are continuous from the skin tag to the inner anal canal