What are the guidelines for evaluation of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Guidelines from most gastrointestinal and surgical societies advocate anoscopy and/or flexible sigmoidoscopy to evaluate any bright-red rectal bleeding. The American Society of Colon and Rectal Surgeons (ASCRS) recommends complete endoscopic evaluation of the colon in select patients with symptomatic hemorrhoids and rectal bleeding. [14] Colonoscopy should be considered in the evaluation of any rectal bleeding that is not typical of hemorrhoids such as in the presence of strong risk factors for colonic malignancy or in the setting of rectal bleeding with a negative anorectal examination. Other colonoscopic screening criteria include the following patient features [14] :

  • Age 50 years or older, if there hasn't been a complete examination within 10 years
  • Age 40 years or older or 10 years younger than the age at diagnosis for a positive history for: (1) a single first-degree relative with colorectal cancer or advanced adenoma diagnosed at younger than 60 years; or (2) two first-degree relatives with colorectal cancer or advanced adenomas
  • A positive fecal immunochemical testing (FIT)
  • A positive FIT-fecal DNA test

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