What tests can help to distinguish between a pile, abscess or fistula?

A painful lump in the anus can be due to piles, abscess or even anal fissure. The most important assessment is by examination of the anus and rectum. This is performed in the clinic with digital rectal exam (using a finger) as well as inserting a short anal probe (less than 7cm deep) to see the inside of the anus. This should be sufficient to confirm the diagnosis. In rare circumstances, if the clinical exam is not able to confirm the diagnosis, your doctor may request for an ultrasound or MRI. While all doctors are trained to examine the anus, a colorectal surgeon will be your best option as he/she is trained to manage all the different conditions of the anus.