CONSULT REQUEST GUIDELINES                                                                         Print


Suggested Pre-Referral Evaluation and Management Guidelines View photo of Prolapsing internal/external hemorrhoid:
Prolapsing internal/external hemorrhoid

1. Almost all patients with symptoms of one kind or another in the anorectal region will complain of "hemorrhoids". It is important to try to define exactly what the symptoms are, to examine the anorectal area and document the findings prior to referral.

2. One should also inquire and document the nature and frequency of bowel movements. Patients who are constipated, have hard stools, strain at stools, or have infrequent bowel movements (e.g., every 3 days), should first have treatment directed at improving their bowel habit.
This can be done by giving them specific instructions on a high fiber diet. (see below).

3. Pain and bleeding with bowel movements is rarely the result of hemorrhoidal disease, and much more likely caused by anal fissure. Attempts to correct bowel habit should be tried prior to referral.

4. Patients with painless rectal bleeding and/or prolapse of tissue during defecation, not associated with hard bowel movements, straining, etc., should be referred for evaluation.

Strangulation of a prolapsed internal hemorrhoid is a rare but exceptionally painful complication of chronic hemorrhoidal prolapse, and requires immediate attention.

Suggested Additional Test/Management Prior to Specialty Visit

Blood seen only on toilet tissue is caused by ANAL bleeding.

Anoscopy is indicated and will be done at time of visit. Colonoscopy is not necessary.
Patient Education/Information (includes preps)

A high fiber diet can be achieved by daily use of a high fiber cereal (i.e., All-Bran, Fiber One, Bran Buds, Kashi cereals with >10 grams of fiber per serving) ½ to 1 cup of cereal daily.


by using a fiber supplement (i.e., Metamucil, Citrucel, Benefiber, etc.). A sufficient amount must be taken daily to give 10-20 grams of fiber. This usually means tablespoons not teaspoons of supplement.

OR both.

The added fiber must be taken every day. It is not a cathartic. Beneficial effects take days to weeks as the colon adapts to the new diet.

Miralax is another alternative, but should be reserved for patients who cannot tolerate or are unable to manage a high fiber diet.

For patients with severe, chronic constipation, or in whom one is concerned about dysmotility, referral to the Michigan Bowel Control Program is suggested.

Appointment Timeframe 4-8 weeks
How to Get Results to Consultant UMHS Patients: See CareWeb
External Patients: Hand carry Non-UM records to visit
Clinic Contact Information Physicians: 800-962-3555
Clinic Location Sites  
UM Consulting Physician Richard E Burney, M.D.
Mary Beth Benedict, M.D.
Jerry Reed, P.A.
Arden Marie Morris, MD
Karin M Hardiman, MD
Scott E Regenbogen, MD
Michigan Bowel Control Program (severe constipation)
Revised on: 08/19/2011



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