Haemorrhoids (piles) - Diagnosing piles (haemorrhoids)

Piles (haemorrhoids) can be easily diagnosed by your GP. To do so, they will examine your back passage to check for swollen blood vessels.

Some people with haemorrhoids are reluctant to see their GP. However, there’s no need to be embarrassed – all GPs are used to diagnosing and treating piles.

It's important to tell your GP about all your symptoms – for example, tell them if you've recently lost a lot of weight, if your bowel movements have changed or if your stools have become dark or sticky.

Rectal examination

Your GP may examine the outside of your anus to see if you have visible haemorrhoids, and they may also carry out an internal examination called a digital rectal examination (DRE).

During a DRE, your GP will wear gloves and use lubricant. Using their finger, they will feel for any abnormalities in your back passage. A DRE should not be painful, but you may feel some slight discomfort. 

Read more about rectal examinations. 

Proctoscopy

In some cases, further internal examination using a proctoscope may be needed. A proctoscope is a thin hollow tube with a light on the end that is inserted into your anus.

This allows your doctor to see your entire anal canal (the last section of the large intestine). During the procedure, your doctor may also take a small tissue sample (biopsy) from inside your rectum so it can be tested in a lab.

A proctoscopy can sometimes be carried out by your GP. However, not all GPs have the correct training or access to the right equipment, so you may need to go to a specialist.

Types of haemorrhoids

After a rectal examination or proctoscopy, your doctor can determine what type of haemorrhoid you have.

The two main types of haemorrhoids are those that develop internally or externally.

Internal haemorrhoids develop above a visible line called the dentate line, and external haemorrhoids are below it. This line marks where the nerves in the anal canal can detect pain. The nerves below the dentate line can detect and transmit pain messages, while the nerves above it can't.

Haemorrhoids can be further classified, depending on their size and severity:

• first degree – small swellings that develop on the inside lining of the anus and are not visible from outside the anus
• second degree – larger swellings that may come out of your anus when you go to the toilet, before disappearing inside again
• third degree – one or more small soft lumps that hang down from the anus and can be pushed back inside (prolapsing and reducible)
• fourth degree – larger lumps that hang down from the anus and cannot be pushed back inside (irreducible)

It's useful for doctors to know what type and size of haemorrhoid you have, as they can then decide on the best treatment. Read more about treating haemorrhoids.