Hemorrhoids and Fecal Occult Blood Tests
Relationship Between Hemorrhoids and Fecal Occult Blood Tests
- Hemorrhoidal bleeding typically presents as bright red blood that may drip or squirt into the toilet bowl, rather than occult (hidden) blood that would be detected on a Hemoccult test 1
- When a positive fecal occult blood test is found in a patient with hemorrhoids, this finding should not be attributed to the hemorrhoids without further investigation 2
- Complete colonic evaluation by colonoscopy or air-contrast barium enema is indicated when a patient has a positive stool guaiac test, even if hemorrhoids are present 3
Diagnostic Approach for Positive Hemoccult with Hemorrhoids
Initial Assessment
- Collect a focused medical history and perform a complete physical examination, including digital rectal examination, to rule out other causes of lower gastrointestinal bleeding 4
- Check vital signs, determine hemoglobin and hematocrit, and assess coagulation to evaluate the severity of any bleeding 5
Further Investigation
- Anoscopy and flexible sigmoidoscopy represent the minimum evaluation for bright-red rectal bleeding 1
- Complete colonic evaluation is mandatory when the bleeding is atypical for hemorrhoids, no source is evident on anorectal examination, the patient has significant risk factors for colonic neoplasia, or a positive Hemoccult test is present 1, 6