Reference no: EM133900637

Question

Reasons to refer patients to a specialist include refractory or complicated internal hemorrhoids for possible intervention and rectal bleeding for possible colonoscopy. Symptomatic low-grade (I or II) internal hemorrhoids refractory to six to eight weeks of medical treatment, Symptomatic high-grade (III or IV) internal hemorrhoids, and thrombosed hemorrhoids, except for subacute (older than three days) thrombosed external hemorrhoids. For patients who present with rectal bleeding, colonoscopy is generally recommended for those ≥40 years to exclude more serious underlying diseases. Also, patients with hemorrhoids and one of the following conditions should be referred for colonoscopy regardless of age, which include Anemia, bleeding that is atypical of hemorrhoids, a concomitant change in bowel patterns, a history of colorectal polyps, a family history of inflammatory bowel disease or colorectal cancer in a first-degree relative, or other suspected pathologic pelvic changes that could contribute to the patient's symptoms.