If seen late w/ sx improving and clot already resorbing, may be allowed to resolve w/o excision

² Exam: viz inspect anus @ rest/straining, digital exam. Dx hemorrhoids by hx, exam. Lab tests almost never helpful. No additional w/u or classification required for thrombosed external hemorrhoids. If there is bleeding, source often requires confirmation by endoscopic studies [SR/M]. Hemorrhoid-pattern bleeding (painless bleed w/ BM) mandates at least sig to r/o other bleed source. If ≥50 yo or if suggestive FHx, may be occasion for entire colon eval, usually by colonoscopy.