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Haemorrhoids G001

Last amended 
13 August 2019
Current RMA Instruments
Reasonable Hypothesis SOP
3 of 2017
Balance of Probabilities SOP
4 of 2017
Changes from previous Instruments

SOP Bulletin 147

ICD Coding
  • ICD-9-CM Codes:455, 671.8
  • ICD-10-AM Codes: I84, O22.4, O87.2
Brief desciption

Haemorrhoids are normal vascular structures in the anal canal.  The disease "haemorrhoids" occurs when these structures become enlarged or inflammed and cause symptoms (such as bright red blood per rectum, anal pruritus, and acute onset perianal pain). 

Confirming the diagnosis

Diagnosis is based on history, physical examination and the exclusion of other causes for any reported symptoms.  The diagnosis can be made by a general practitioner.

The relevant medical specialist is a general or colorectal surgeon.

Additional diagnoses covered by SOP

  • External haemorrhoids
  • Internal haemorrhoids
  • Piles
  • Thrombosed external haemorrhoid/pile
Conditions not covered by SOP
  • Anorectal varices - non-SOP
  • Asymptomatic (enlarged) haemorrhoids - N.I.F.
Clinical onset

Enlarged haemorhoids may be asymptomatic and found incidentally.  These do not constitute a disease.  Symptoms of haemorrhoids include bright red bleeding per rectum, anal pruritus (itch), prolapse, and pain due to thrombosis.  Clinical onset will be when symptoms, not attributable to another disorder, first manifest.

Clinical worsening

The usual course of haemorrhoids is for symptoms to persist or slowly worsen.  Symptoms may be improved or controlled by a range or treatment options, including conservative measures, non-surgical procedures and surgical procedures.  Specialist opinion should be sought if worsening, beyond the normal course of the disease, needs to be considered.