Diagnosing haemorrhoids (piles)

Your GP can diagnose haemorrhoids (piles) by examining your back passageto check for swollen blood vessels.

Some people with haemorrhoids are reluctant to see their GP. But there's no need to be embarrassedall GPs are used to diagnosing and treating piles.

It's important to tell your GP about all of your symptoms for example, tell them if you've recently lost a lot of weight, if your bowel movements have changed, or if yourstools have become dark or sticky.

Rectal examination

Your GP may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called a digital rectal examination (DRE) .

During a DRE, your GP will wear gloves and use lubricant. Using their finger, they'llfeel for any abnormalities in your back passage. A DRE shouldn't be painful, but you may feel some slight discomfort.

Proctoscopy

In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin, hollow tube with a light on the end that's inserted into your anus.

This allowsyour doctor to see your entire anal canal, the last section of the large intestine.

GPs are sometimes able to carry out a proctoscopy. However, not all GPs have the correct training or access to the right equipment, so you may need togo to ahospital clinicto have the procedure.

Types of haemorrhoids

After you've had a rectal examination or proctoscopy, your doctor will be able todetermine what type of haemorrhoids you have.

Haemorrhoids can develop internally or externally. Internal haemorrhoids develop in the upper two-thirds of your anal canal, while external haemorrhoids develop in the lower third, closest to your anus.

The nerves in thelower part can transmit pain messages, while the nervesin the upper partcan't.

Haemorrhoids can be further classified, depending on their size and severity:

• first degree small swellings that develop on the inside lining of the anus and aren't visible from outside the anus
• second degree larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again
• third degree one or more small soft lumps that hang down from the anus and can be pushed back inside(prolapsing and reducible)
• fourth degree larger lumps that hang down from the anus and can't be pushed back inside(irreducible)

It's useful for doctors to know what typeand size of haemorrhoid you have, as they can then decide on the best treatment.

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