Step by step
Examination of anus and perianal area
Examine the anus by inspection for signs of: perianal dermatitis; anal fissures; fistulas and external hemorrhoids.
Examine the anus by palpation to assess: the anal sphincter tone; the size and location of the hemorrhoids and to check for any other palpable lesions (e.g. fibromas).
Assessment of prolapse
If the patient is conscious during the procedure, they may be asked to strain (Valsalva maneuver) to determine the extent of the prolapse and if spontaneous reduction occurs. Under anesthesia (spinal or general), the sphincter muscles relax and the prolapse of the polyp may be more prominent. Hemorrhoidal prolapse may be more prominent in the anesthetized patient. The degree of hemorrhoidal prolapse should be evaluated when the patient is conscious and without anesthesia.
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