Patients with acute prolapsed or thrombosed hemorrhoids usually appear ill and in pain. Physical examination of patients with hemorrhoids is usually remarkable for scratch marks at the anal verge, prolapsed external hemorrhoids, and tenderness on digital rectal examination.

Patients with acute prolapsed or thrombosed hemorrhoids usually appear ill and in pain.^[1]

Unless the hemorrhoids are infected, vital signs are usually within normal limits.

• Inspection of the anal verge may show scratch marks and skin tags.
• Inspection also may reveal external hemorrhoids or prolapsed internal hemorrhoids, which may appear as a bluish-purple mass near the anal orifice.

• Digital rectal examination reveals the size and location of hemorrhoids.
• Thickness and tone of anal sphincter must be assessed both at rest and during contraction by asking the patient to squeeze the anal sphincter around a gloved finger.
• Thrombosed hemorrhoids are tender to palpation.
• Internal hemorrhoids are not palpable by digital rectal examination and the use of anoscope is mandatory.
• If rectal bleeding is noted in the absence of a bowel movement, a Colonoscopy must be done to rule out Colon Cancer.