Internal hemorrhoids can be seen as smoothly marginated and curved filling defects that project into the rectal vault, lying adjacent to the rectal tube tip (Fig. 14.1). In contradistinction, low rectal cancers will normally have shouldering, and arise some distance from the anus itself. Physical examination usually confirms the presence of internal hemorrhoids. If the remainder of the colorectum has been cleared of significant lesions, a limited proctoscopic or sigmoidoscopic examination can be performed, if digital examination is nondiagnostic.
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