Most of these overlap, and several are routinely mistaken for each other. A fissure and a hemorrhoid both bleed. A skin tag and a prolapse both feel like a lump. The examination is what separates them.
Nearly everyone arrives describing bleeding, a lump, or itching. Those three cover hemorrhoids of every grade, anal fissures, skin tags, and several conditions that are none of those. The description alone does not sort them, and it is not meant to.
Pain is the most useful early clue. Internal hemorrhoids are usually painless because of where they sit; a fissure is sharply painful on passing stool; a thrombosed external hemorrhoid is a sudden firm lump that hurts constantly. None of that is diagnostic alone, which is why an anoscopy is part of the first visit.
Each page below describes one presentation and what tends to be behind it, including the cases where the answer is a doctor, not a procedure, and what treatment usually follows once the grade is known, along with roughly how long that normally takes.
Montreal assessment
The route
From symptom to your Montreal treatment plan
Describe it
Where it is, whether there is bleeding, and how long. You do not need to name the condition to get an appointment.
Examination
An external look and an anoscope examination separate hemorrhoids from fissures, tags and prolapse, and give the grade.
The options
What is worth treating, what is worth leaving, and whether anything here needs a colonoscopy or a specialist first.
Treatment or referral
Either a procedure booked with a plan behind it, or a referral onward, said at the first visit rather than the sixth.
Symptoms we assess
What Montreal hemorrhoid treatment covers
Each page covers what the presentation usually turns out to be, what tends to settle it, and the findings that need a doctor instead.
What people ask before booking, when they are not sure the problem is the sort we handle.
No. Describing where it is, whether there is bleeding and how long it has gone on is enough. Separating a hemorrhoid from a fissure or a skin tag is the examination’s job, not yours.
Pain is the usual clue. Internal hemorrhoids are often painless; a fissure is sharply painful when you pass stool. That is suggestive rather than conclusive, which is why both are confirmed by examination.
No. A skin tag, a thrombosed external hemorrhoid and a prolapsed internal one all present as a lump, and they are treated differently. A firm bluish lump that arrived suddenly and hurts constantly suggests a clot.
Mild ones often do, with more fibre, more fluid and less time straining on the toilet. The ones treated here are the ones that have not settled, or that keep returning after they seemed to.
No. Rectal bleeding is the commonest hemorrhoid symptom and also a presenting symptom of colorectal cancer, so it is assessed rather than assumed. Bleeding that lasts beyond a week or keeps returning needs looking at.
Yes. Pregnancy is one of the things screened for before banding, so care during pregnancy is usually conservative, with procedures considered afterwards if symptoms persist once you have recovered.
The symptoms hub
How these pages are written
One presentation per page
Each page starts from the symptom people actually search, not from a textbook chapter, and says what tends to be behind it.
Warning signs included
Every page names the findings that need medical assessment instead of a procedure, because leaving those out is the dangerous omission.
Overlaps spelled out
Fissures, skin tags and prolapse are described alongside hemorrhoids, because all three are routinely mistaken for them.
Linked to the treatment
Where a page points to an approach, it links to the treatment page that explains what that approach does and who it suits.
Describe the problem in a sentence or two and roughly how long it has gone on. A clinician reads it before the appointment, and the visit starts with the examination.
