A number of conditions that affect the end portion of the large intestine (anal canal) and colon (large intestine) can cause bleeding, mucous drainage, itching, and discomfort. Most people who have these symptoms think they have hemorrhoids, but that is often not the case.

The purpose of a doctor visit to evaluate symptoms of hemorrhoids is to rule out other, more serious problems. If hemorrhoids are present, the doctor will determine their location and their size (if internal) and develop a treatment plan. The treatment plan is based on the degree of severity (grade) of the hemorrhoids.

The diagnosis of hemorrhoids is based on a medical history and physical exam. If a doctor thinks that hemorrhoids are the obvious cause of rectal bleeding in a person younger than age 50, a digital rectal exam and an anoscopy are the only tests needed for an initial evaluation.

If you are older than age 50, or if anoscopy does not provide a clear diagnosis, a flexible sigmoidoscopy may be the next test needed.

If the source of rectal bleeding isn't found by flexible sigmoidoscopy, your doctor may use a fecal occult blood test, a barium enema, and/or a colonoscopy to try to determine if the source of bleeding is higher up in your digestive tract. These tests are not routine methods for diagnosing hemorrhoids.

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