This section is from the book "Diseases Of The Intestines", by Max Einhorn. Also available from Amazon: Diseases Of The Intestines A Text-Book For Practitioners And Students Of Medicine.
The diagnosis of hemorrhoids as a rule is easy. External piles are found by inspection of the anus, the patient lying on his side with the thighs drawn up. The buttocks are pushed aside with the hands, and the patient is instructed to strain in a similar manner as when having a stool. Nodules of a reddish-bluish tinge will be noticed in the immediate vicinity of the anus or partly within it. It is characteristic of hemorrhoidal nodules to increase in size during a period of constipation, and to diminish after an efficient evacuation of the bowels.
Condylomata and small skin tags around the anus can be easily differentiated from piles. Condylomata, as a rule, encircle the anus and are present also on other parts of the body, especially on the scrotum. Besides, there will be a previous history of syphilis, and occasionally other luetic manifestations. The cutaneous tags present more the appearance of whitish-looking skin, never change in size, and do not bleed when punctured, while hemorrhoids bleed profusely on puncture.
The diagnosis of internal hemorrhoids can be made by a digital examination or by this in connection with the inspection of the lower portion of the rectum by means of a speculum. The characteristics of internal piles are similar to those of external hemorrhoids. They can be easily differentiated from polypi by means of puncture with the needle. Polypi do not bleed when punctured. Besides, polypi are usually found in children, while hemorrhoids occur with greatest frequency in the advanced period of life.
Carcinoma of the rectum will rarely give rise to mistakes, the tumor usually presenting a much harder consistency than hemorrhoids. As a rule, there will also be other signs of a malignant trouble, cachexia, etc. It is needless to say that cancer of the rectum may be combined with hemorrhoids. As a matter of fact, it very often gives rise to their development, and the discovery of piles which have formed within a short period of time should indeed rouse the suspicion of cancer of the rectum.
The prognosis of external as well as internal piles is as a rule favorable. They generally exist for a long time, not infrequently throughout life. They hardly ever endanger life, unless some grave complications (incarceration of the hemorrhoids or gangrenous processes or very profuse hemorrhages) supervene. Hemorrhoids are liable to recede or even to disappear entirely, especially if the factors producing them have been eliminated.