In order to detect if a person has hemorrhoids, most colon and rectal surgeons use physical examination. Many patients with anal complaints, however, dread the going through this procedure. Often, they experience repeated rectal examination and anoscopies from inexperienced examiners. Thus, it is important to suppress the fears of these patients before going to performing any examination if any meaning is to be acquired.

For the examination, you’re going to lie in the left lateral Sims or decubitus position. This is more comfortable, and is usually less humiliating and easier to hold than the lithotomy or prone jackknife positions. It’s important to know that you are going to need to lie such that the examiner is going to get a good view of the anal area.

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.

When the anoscope is inserted, it should be positioned such that the open portion is in the right anterior, after which it’s placed in the right posterior, and lastly in the left lateral positions so that hemorrhoidal bundles can be observed. As the doctor examines, a pathologist is also going to observe and see whether dilated vascular spaces exist that may inhibit recanalization or thrombosis.

In some cases, you may also be required to undergo a colonoscopy or sigmoidoscopy if the examiner needs more detail. If any prolapses have occurred with hemorrhoids, you may be requested to again bear down or strain after the procedure is complete. Anal outlet bleeding does happen with hemorrhoids, but it can also be a sign of colorectal cancer, which is a concern. Therefore, if you have rectal bleeding, you will need to be examined further to make sure only hemorrhoids and no other diseases are present.