How piles are diagnosed, hemorrhoids differential diagnosis, laboratory test for hemorrhoids

Hemorrhoids, also called piles are a cluster of inflamed and swollen veins, muscles, and tissues in the anal region. Hemorrhoids are quite a high prevailing anorectal disease that can affect anyone. However, people with unhealthy eating habits and inactive lifestyles are more susceptible to developing piles. Blood in stools, pain during bowel movements, swelling, and itching in the anal area are the common symptoms of piles. 

Depending upon the location, there are two types of piles or hemorrhoids:

  • External hemorrhoids- These form under the skin surrounding the anus.
  • Internal hemorrhoids- These form in the inner lining of the anus and lower rectum.

Proper diagnosis and treatment for both types of piles are highly necessary to keep away unprecedented complications. Some people tend to diagnose themselves out of embarrassment and neglect seeking a specialist’s consultation. Self-diagnosis and self-medication can be dangerous and may lead to serious health problems. Thus, it is safe to only visit a proctologist for piles diagnosis.

Read also: Never try these treatment methods to cure piles.

Proctologists use the following methods for the diagnosis of piles:

Medical History

The first and foremost thing for the doctors while diagnosing piles is to openly discuss the medical history of the patient in detail. The proctologists also usually ask about the dietary habits and lifestyle of the patient to gain a clear understanding of the condition. Any history of enema or laxative use is also important to be mentioned to the doctor.

Physical Exam

In the physical exam, the doctor takes a look at the anus to check for visible symptoms of hemorrhoids, called a rectal exam. The unusual symptoms are easily identifiable in the case of external hemorrhoids

Rectal exam

It is a quick procedure that does not inflict any major pain. It is a common diagnostic test performed by proctologists and it is nothing to be embarrassed about. For a proper rectal exam, the patient needs to change into a hospital gown.

The doctor will use gloved hands to check the anus and the skin surrounding it (perianal area).  The doctor will check the region for any lumps, swelling, irritated skin, tear/cut in the anus (anal fissure), or a blood clot(s) in veins if the hemorrhoids are external.

It is easier to diagnose external hemorrhoids through a physical exam. However, this physical diagnostic test also helps in checking if the internal hemorrhoids have collapsed through the anal opening, called prolapse.

In most cases, in addition to the physical exam, the proctologist also conducts digital exams to thoroughly check the anal muscles and look out for internal hemorrhoids, tenderness, masses, or lumps.

Digital Rectal Exam

Before going for a digital rectal exam, it is better to empty the bladder and/or pass bowels. Doing so will help in going through the test(s) more comfortably. You can ask your doctor for any other instructions to follow before the test.

Also read: Piles treatment cost in different cities of India

For the diagnosis of internal hemorrhoids, proctologists conduct the following digital rectal exams :


It is a short procedure that completes within a few minutes. This digital rectal exam procedure is conducted with the help of a device called an anoscope.

This device is either made up of disposable plastic or stainless steel that can be sterilized and has a light mounted on its tip. It enables the proctologist to get a clear visual of the tissues or inner lining of the anorectal region.

Through anoscopy, the doctor is able to check the presence of internal hemorrhoids and their severity. During anoscopy, the doctor will first gently insert a gloved and lubricated finger to locate the hemorrhoids and the anoscope.

Also Read: Which doctor should we consult for piles treatment?

The patient may experience mild discomfort and no significant pain during anoscopy. Furthermore, anoscopy can also detect anal fissures, cancer of the anus or the rectum, and anal polyps (unusual growths in the lining of the anus).

If the doctor locates any abnormal cells, they would collect a sample of the tissue for testing with help of a swab or any other tool.

Rigid proctosigmoidoscopy

This diagnostic test for hemorrhoids is similar to anoscopy and is performed as an outpatient procedure. In a rigid proctosigmoidoscopy procedure, the doctor uses a device called a proctoscope to clearly view the lining of the rectum and the lower colon (a part of the large intestine). The proctologist will thoroughly check the internal tissues of the rectum and colon for any bowel disease or digestive tract issue. Anesthesia is required for rigid proctosigmoidoscopy in only a few cases. Through this procedure, the doctor can confirm internal hemorrhoids along with any digestive tract issues that the patient may be suffering from. 

Hemorrhoids Differential Diagnosis

In case of extremely painful and bleeding piles, it becomes crucial for doctors to rule out any other medical condition that might cause almost the same symptoms. Cancer of the colon and rectum (colorectal cancer), polyps in the colon can also cause piles like symptoms in elderly people. 

The above mentioned diagnostic tests help in ruling out the following conditions that cause piles like symptoms:

  • Anal fissure- It is a tear or cut in the mucosal lining of the anus and anal opening. The tissues in the anal area are soft and thin, and thus they are susceptible to cut or damage on excessive straining. Passing hard and large stools is a common cause of anal fissure.
  • Anal fistula- It is more common in people with a history of anal abscess. An anal fistula is an unusual infected channel or tunnel that develops between the anus and perianal skin. In most cases, the infected anal gland is the reason for the anal fistula to form. Immediate surgical treatment is necessary for this condition.
  • Polyp-  A polyp is a small outgrowth of tissues in the lining of the colon or rectum. Not all polyps are malignant/cancerous but leaving them untreated can make the symptoms grow severe with time.
  • Inflammatory bowel disease (IBD)- IBD is a broader term used to define various disorders of the digestive tract that involve chronic inflammation. People who suffer from IBD experience diarrhea or abdominal pain along with anal bleeding.

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What to do if you are diagnosed with piles? 

If your proctologist diagnoses you with piles, it is best that you get the treatment as soon as possible. Only a proctologist can provide you with the best treatment for piles.

One of the most sought-after treatments for piles that proctologists prefer currently is laser treatment. Our experienced proctologists at Pristyn Care also offer advanced laser treatment for piles.

The advanced laser treatment is minimally invasive, painless, and takes less than 30 minutes to complete. There are no cuts, wounds, or stitches involved and it is performed as an outpatient procedure.

You can resume working from the next day and recover smoothly within just a week. Also, the chances of recurrence of piles and post-surgery complications are almost nil in the case of laser treatment. 

You can reach out to us if you have any queries regarding piles diagnosis and treatment. Call us directly on the abovementioned number or click on the ‘Book Appointment’ icon and submit the details for scheduling your consultation.

Read also: Know everything about piles laser treatment.

As soon as you submit it, one of our medical coordinators will reach out to you to confirm the appointment according to your convenience.

Take Away

Anyone can suffer from piles and it is a medical condition that needs immediate medical care. Indulging in self-check and relying on home remedies or medication without a prescription is not safe.

It is crucial to undergo laboratory tests for hemorrhoids as soon as you experience the symptoms. The sooner you get a medical diagnosis, the faster you can get rid of piles. Get in touch with us now to get the best diagnosis and treatment for piles.

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