What is the first diagnostic step for patients suspected of having hemorrhoids without cancer features?

In patients suspected of having hemorrhoids, the initial diagnostic step is anoscopy. This procedure allows for direct visual examination of the anal canal and lower rectum, providing the opportunity to identify and assess any hemorrhoids present. Anoscopy is particularly useful in differentiating between internal and external hemorrhoids and can help rule out other potential causes of rectal bleeding or anal discomfort.

Anoscopy is a simple, office-based procedure that can be performed with minimal equipment, making it a practical choice for initial evaluation. It allows healthcare providers to not only confirm the presence of hemorrhoids but also to assess their size and degree of prolapse, which is critical for determining the appropriate treatment plan.

Other diagnostic modalities, such as abdominal ultrasound or CT scans, are not typically first-line investigations for hemorrhoids as they are more suited for assessing deeper abdominal structures or for identifying other conditions. A digital rectal exam, while useful for evaluating rectal tone and other abnormalities, does not provide the same level of visualization as anoscopy and may not accurately assess hemorrhoids specifically.