Hemorrhoids Differential Diagnoses

Updated: May 31, 2022
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Diagnostic Considerations

Cardinal signs of internal hemorrhoids are painless bleeding and intermittent protrusion. [17] The diagnosis generally requires exclusion of other conditions with similar symptoms.

Hemorrhoidal complaints are usually not associated with other medical conditions or diseases. However, patients with the following diseases and conditions have an increased risk of hemorrhoidal complaints:

  • Inflammatory bowel disease (IBD): IBD and hemorrhoidal problems occur frequently; unusual hemorrhoidal presentations and findings should alert the clinician to the potential of IBD. [13]

  • Ulcerative colitis and Crohn disease

  • Pregnancy

Thrombosis of external hemorrhoids may result from clot formation in a vein under the squamous epithelium of the anal verge.

Varicosities caused from portal hypertension are a distinct entity from hemorrhoids.

Other conditions that should be considered when evaluating a patient with suspected hemorrhoids include anal cancer, anal fissures, and anal fistulae; pedunculated polyps; perianal abscesses; pruritus ani; prostatitis; proctitis, rectal prolase, proctalagia fugax; skin tags; condyloma; inflammatory bowel disease; and colorectal tumors. [18]

Differential Diagnoses