If someone has hemorrhoids, usually, a doctor will perform a physical examination to determine this. For example, if you are patient and you have pain in your anal area, you may undergo this, although you may also certainly dread doing so. If you are having particular difficulties, you may need several rectal examinations, and you may need to need to get anoscopies; this can be particularly difficult if the examiner is not particularly experienced. However, it's important to allay your fears with your doctor before you undergo this examination so that the examination itself can produce the information needed.
First, as the patient, you're going to be in the Sims or left lateral decubitus position, because this is going to make things easier. It's also less embarrassing than prone jackknife or lithotomy positions. You'll need to be in this position such that the doctor can get a clear view of your anus for examination.
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.
Generally, this kind of position will ensure good exposure of the anal area to be examined with least discomfort to the patient. When starting to examine, the buttocks should be tenderly spread, include the external perineal area for any eczematous lesions, rashes or any abnormal findings. The external sphincter must be asked to be contracted to assess if there are deviations from normal function.
After this is complete, you'll generally be asked to push or bear down as though you were going to have a bowel movement; simultaneously, the examiner will insert a lubricated finger gently into the anus for what is called the digital examination. This examination should only take a minute or two, and is typically not painful, just uncomfortable.
Anoscopy is usually done after the digital examination is complete. This is done so that the examiner can visually confirm that you do have hemorrhoids using an anoscope, which is a device that looks like a hollow tube with a light attached at the end, attached to a machine that lets the examiner view the air yet clearly. Side viewing anoscopes are used for these examinations instead of end viewing anoscopes because side view anoscopes lead the examiner look at the anal canal and 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, other tests are also required, such as a colonoscopy or sigmoidoscopy, if more detail is needed. To find out if any hemorrhoidal prolapses have occurred, patients are you also usually required to push or strain slightly after the examination; f any anal bleeding occurs, it's usually due to hemorrhoids, but may also be indicative of colorectal cancer. This is why it's very important to check this. If rectal bleeding does exist, further examination is necessary to make sure other diseases beside hemorrhoids are not also present.
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