Diagnosis

Abstract

The diagnosis of hemorrhoids is simple but often tricky. Perhaps there is no other condition that is as often misdiagnosed as hemorrhoids. Both patients and physicians tend to blame "hemorrhoids" for a multitude of problems in the anorectal area, often with dangerous consequences. I have seen many cases where "hemorrhoids" were blamed for the patient's symptoms and even treated for years, when the actual pathology was either a fissure, fistula, prolapse, anal papilla, or in some cases even a carcinoma. It should be made clear right at the outset that the diagnosis of "hemorrhoids" should be reached only after confirming the hemorrhoids on visual and anoscopic examination and only after other sources of anorectal symptoms have been excluded. Needless to say, if a proper history is taken and a complete anorectal exam is performed, there should be no difficulty in reaching the correct diagnosis. As with any other medical condition, diagnosis requires a proper history and a detailed physical examination [1]. A properly taken history and physical exam will not only help make the diagnosis of hemorrhoids but also steer the surgeon towards making the correct treatment choice for a particular patient. In my opinion, the true caliber of a colorectal surgeon can be judged not by his degrees but by the care and expertise he demonstrates in the diagnosis of common anorectal ailments such as hemorrhoids. © Springer-Verlag London Limited 2009.