How Are Hemorrhoids Diagnosed?

One of the reasons people delay getting evaluated for hemorrhoids is that they don't know what to expect — and the not-knowing makes the whole thing feel scarier than it actually is. In reality, a hemorrhoid evaluation is one of the more straightforward things in medicine. Here's exactly what it involves.

Your first appointment begins with Dr. Chung simply listening. You'll be asked about your symptoms — when they started, how often they occur, what makes them better or worse. He'll ask about your bowel habits: frequency, consistency, whether you strain, how long you typically spend on the toilet.

Diet, hydration, exercise, medications, and your personal and family medical history all factor into the picture. A history of colorectal conditions in the family or prior anorectal issues will affect how thorough the evaluation needs to be.

After the history, Dr. Chung will do a brief physical examination of the perianal area — the skin around the anus. This visual inspection can reveal external hemorrhoids, skin tags, fissures, or other visible issues.

A digital rectal exam (a gloved finger gently inserted into the rectum) is often the next step. It helps identify internal abnormalities and takes less than a minute. It may feel slightly uncomfortable but should not be painful.

To see internal hemorrhoids clearly, Dr. Chung will use an anoscope — a short, hollow, lighted instrument about the size of a finger. It's gently inserted into the anal canal so he can directly see the hemorrhoidal tissue inside.

No sedation or preparation is needed. The procedure takes a few minutes and is done right in the office. Most patients are surprised by how quick and manageable it is. You can drive yourself to and from the appointment.

Once internal hemorrhoids are identified, they're assigned a grade that guides treatment:

Grade I: Enlarged but don't prolapse — they stay inside the anal canal.

Grade II: Prolapse during bowel movements but retract on their own.

Grade III: Prolapse and need to be manually pushed back in.

Grade IV: Permanently prolapsed and can't be reduced.

External hemorrhoids are assessed separately based on size, location, and whether clotting is present.

For patients with rectal bleeding, significant risk factors for colorectal cancer, or symptoms that don't match the typical hemorrhoid picture, Dr. Chung may recommend a flexible sigmoidoscopy or colonoscopy. These provide a more complete view of the colon and are the gold standard for ruling out more serious conditions.

At CR Surgery OC, the goal is to give you clarity at your first visit — not send you home with vague reassurances. Most patients leave knowing exactly what they have, how advanced it is, and what the options are. That's the starting point for actually fixing the problem.