I have written this article so that hemorrhoids sufferers have an insight as to what they can expect when they finally pluck up the courage to visit the doctor.
So,
you think you have hemorrhoids.
You have read all the information you can find, maybe talked to a few people, possibly tried some home remedies and bought different creams and reluctantly arrived at the conclusion that there is only one course of action left to you, the visit to the doctor. This is the one thing that most of us dread as the thought of exposing an intimate part of our anatomy to anyone other than the closest person to us is absolutely terrifying.
When you finally enter the doctor’s office and sit down, the doctor will ask you some pretty straight forward, rudimentary questions, the same as they would for any other condition. They may want to know why you think you have hemorrhoids, ask you about your medical history, your toilet habits, diet, and whether you have tried any treatments yourself. They will then offer you advice in respect of your answers and once this is done it is time for the examination.
You will be asked to go into an examination area/room and remove the bottom half of your clothing (obviously) and maybe put on an examination robe. They will usually ask you to either lie down on an examination table, though if, like me, your hemorrhoids have prolapsed to such a degree, they may just ask you to bend over. For prolapsed hemorrhoids there is usually no need for further examination and don’t worry, the doctor won’t touch them unless completely necessary.
Once on the table the doctor will ask you to get into a foetal position, which basically means you lie on your side and bring your knees up to your chest. This position is best for a rectal examination as you are more exposed, and will certainly feel that way too. If you are female you will understand that all modesty is left outside as is the case with a cervical smear or vaginal examination.
Whilst you are doing this, the doctor will prepare, procuring the necessary examination apparatus. These are normally a pair of surgical gloves, lubricant and an anoscope. (This is a small instrument, usually about 3 inches long that enables the doctor to see inside the anal canal. As seen in the diagram, the instrument has an obturator which rounds off the end for easier insertion).
The first examination the doctor might perform is called a Palpation. For this the doctor will ask to lie on your back and they will press down on the abdomen to assess the tissue, whether there is any unnecessary pain, swelling etc that may be of note. Not all practitioners will perform this examination for this condition though it does inform them of any other complaints that may be in existence.
The next examination is visual and the doctor will spread your buttocks to check for signs of external hemorrhoids and any inflammation or other tissue abnormalities that may be symptomatic of external hemorrhoids.
After this the doctor will give you a Digital examination. For this the index finger (hence digital) is lubricated and gently inserted into the anal cavity. This is not painful but believe me, it is not a pleasant experience even though the doctor will try to reassure you. (My doctor was thankfully quite a humorous chap which made the whole experience a bit more bearable). Once inserted, the finger is gently moved around the circumference of the wall to feel for any anomalies before being slowly removed.
The examinations listed previously should always be performed before the subsequent examination.
This next examination is the Anoscopy. The aforementioned anoscope is lubricated and (I repeat this a lot) gently rotated as it is inserted into the anal cavity. The obturator is then slowly removed so that the doctor may see into the anal passage. The anoscope is then gently and slowly removed giving the doctor the facility to complete a thorough examination of the anal cavity. You will probably feel a bit uncomfortable for a few hours afterwards, this is perfectly normal.
Once the doctor has completed his examination, you will be given something to clean yourself with and be left to get dressed. Once clothed, the doctor will then ask you to be seated and will then discuss their conclusions with you.
Depending on the prognosis, there are several avenues the doctor may suggest. If hemorrhoids are confirmed, depending on the severity, several treatments will be recommended. This may well be that you are prescribed some creams that are readily available for a price from the chemist/pharmacy and that you more than likely have already tried. They may ask you to come back in for a further examination either by themselves or by a proctologist, or maybe to undergo a surgical procedure to remove them.
Best regards
Simon G
