When should I consider further investigations, such as colonoscopy, in a patient presenting with haemorrhoids?

Further investigations, such as colonoscopy, should be considered in a patient presenting with haemorrhoids primarily if anal or colorectal cancer is suspected NICE CKS. A suspected cancer pathway referral should be used in such cases for an appointment within two weeks NICE CKS. Specific indicators for considering a suspected cancer pathway referral include an unexplained anal mass or anal ulceration, or a rectal mass NICE NG12. For unexplained rectal bleeding, especially in individuals aged 50 and over, or in adults under 50 with unexplained abdominal pain or weight loss, quantitative faecal immunochemical testing (FIT) should be offered NICE NG12. Additionally, referral to an appropriate specialist for further investigation is warranted if another serious pathology, such as inflammatory bowel disease or a sexually transmitted infection, is suspected NICE CKS. Further investigation and management in secondary care are also indicated for people whose haemorrhoids do not respond to conservative treatment or who experience recurrent symptoms despite primary care management NICE CKS.