eMedicine Specialties > Emergency Medicine > Gastrointestinal

Hemorrhoids: Differential Diagnoses & Workup

Author: Kyle R Perry, MD, Resident Physician, Department of Emergency Medicine, Detroit Receiving Hospital
Coauthor(s): Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Contributor Information and Disclosures

Updated: Sep 9, 2009

Differential Diagnoses

Condyloma Acuminata
Inflammatory Bowel Disease
Proctitis
Rectal Prolapse

Other Problems to Be Considered

Anal cancer
Anal fissure
Anal fistula
Pedunculated polyp
Perianal abscess
Pruritus ani
Colorectal tumors

Workup

Laboratory Studies

  • A CBC may be useful as a marker for infection. Anemia due to hemorrhoidal bleeding is possible3 , albeit rare (0.5 cases per 100,000 patients), and its presence should raise suspicion of an alternate diagnosis.

Imaging Studies

  • Proctogram may be indicated in rectal prolapse.

Procedures

  • Proctoscopy may be performed to supplement anoscopy.
  • Full evaluation of the large bowel with colonoscopy is recommended for patients with significant abdominal symptoms, weight loss, change in bowel habits, age older than 50 years, or other risk factors for colonic malignancy.

More on Hemorrhoids

Overview: Hemorrhoids
Differential Diagnoses & Workup: Hemorrhoids
Treatment & Medication: Hemorrhoids
Follow-up: Hemorrhoids
Multimedia: Hemorrhoids
References
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References

  1. Coates. Rosen P, ed. Rosen's Emergency Medicine, Concepts and Clinical Practice. Sixth Edition. Philadelphia, Pa: Elsevier; 2006:1509-1512.

  2. Burgess, Bouzoukis. Tintanelli J, ed. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill; 2004:540-541.

  3. Ibrahim AM, Hackford AW, Lee YM, Cave DR. Hemorrhoids can be a source of obscure gastrointestinal bleeding that requires transfusion: report of five patients. Dis Colon Rectum. Aug 2008;51(8):1292-4. [Medline].

  4. [Best Evidence] Jutabha R, Jensen DM, Chavalitdhamrong D. Randomized prospective study of endoscopic rubber band ligation compared with bipolar coagulation for chronically bleeding internal hemorrhoids. Am J Gastroenterol. Aug 2009;104(8):2057-64. [Medline].

  5. Gupta PJ, Kalaskar S. Radiowave ablation and mucopexy for prolapsing hemorrhoids--a pilot study. Int J Surg. Jun 2009;7(3):223-7. [Medline].

  6. [Guideline] American Gastroenterological Association medical position statement: Diagnosis and treatment of hemorrhoids. Gastroenterology. May 2004;126(5):1461-2. [Medline]. [Full Text].

  7. [Guideline] Cataldo P, Ellis CN, Gregorcyk S, et al. Practice parameters for the management of hemorrhoids (revised). Dis Colon Rectum. Feb 2005;48(2):189-94. [Medline]. [Full Text].

  8. Billingham RP, Isler JT, Kimmins MH. The diagnosis and management of common anorectal disorders. Curr Probl Surg. Jul 2004;41(7):586-645. [Medline].

  9. Fazio VW, Tjandra JJ. The management of perianal diseases. Adv Surg. 1996;29:59-78. [Medline].

  10. Halverson A. Hemorrhoids. Clinics in Colon & Rectal Surgery. Benign Anorectal Conditions. May 2007;77-85.

  11. Janicke DM, Pundt MR. Anorectal disorders. Emerg Med Clin North Am. Nov 1996;14(4):757-88. [Medline].

  12. MacKay D. Hemorrhoids and varicose veins: a review of treatment options. Altern Med Rev. Apr 2001;6(2):126-40. [Medline].

  13. Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treatment of hemorrhoids. Gastroenterology. May 2004;126(5):1463-73. [Medline].

  14. Metcalf A. Anorectal disorders. Five common causes of pain, itching, and bleeding. Postgrad Med. Nov 1995;98(5):81-4, 87-9, 92-4. [Medline].

  15. Parker GS. A new treatment option for grade II and IV hemorrhoids. J Fam Pract. Oct 2004;53(10):799-804. [Medline].

  16. Perrotti P, Antropoli C, Molino D, et al. Conservative treatment of acute thrombosed external hemorrhoids with topical nifedipine. Dis Colon Rectum. Mar 2001;44(3):405-9. [Medline].

  17. Pfenninger JL, Surrell J. Nonsurgical treatment options for internal hemorrhoids. Am Fam Physician. Sep 1 1995;52(3):821-34, 839-41. [Medline].

  18. Scaglia M, Delaini GG, Destefano I, Hulten L. Injection treatment of hemorrhoids in patients with acquired immunodeficiency syndrome. Dis Colon Rectum. Mar 2001;44(3):401-4. [Medline].

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Further Reading

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Keywords

hemorrhoids, hemorrhoid treatment, hemorrhoid causes, hemorrhoid symptoms, anus swellings, piles, cutaneous hemorrhoids, external hemorrhoids, internal hemorrhoids, hemorrhoidal venous plexus, hematochezia, varicosities of the hemorrhoidal venous plexus, thrombosed external hemorrhoid, rectal bleeding, prolapsed hemorrhoid, rectal prolapse

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Contributor Information and Disclosures

Author

Kyle R Perry, MD, Resident Physician, Department of Emergency Medicine, Detroit Receiving Hospital
Kyle R Perry, MD is a member of the following medical societies: American Medical Association, Emergency Medicine Residents Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD, MS, Assistant Professor, Department of Emergency Medicine, Wayne State University/Detroit Receiving Hospital
Adam J Rosh, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

William G Gossman, MD, Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Consulting Staff, Department of Emergency Medicine, Creighton University Medical Center
William G Gossman, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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