There are three main symptoms of internal hemorrhoids, namely bleeding, swelling and pain, and prolapse, and once these symptoms occur, only then is surgery considered appropriate. However, whether a colonoscopy must be done before surgery is determined on a case-by-case basis. In general, proctoscopy is sufficient before hemorrhoid surgery, and some units can also perform anoscopy only. If the hemorrhoid is predominantly bleeding and the bleeding cannot be accurately determined as a hemorrhoid during the clinical examination, colonoscopy should be performed in this case. It is generally advocated that a colonoscopy should be done universally over the age of 40 to enable early detection of rectal polyps, rectal tumors, intestinal inflammation, etc., to be ruled out in a timely manner. If you have the conditions to do a colonoscopy or suspect intestinal problems, it is also necessary to perform a colonoscopy. The colonoscopy is an invasive examination, so it is necessary to be careful during the examination. If the diagnosis of internal hemorrhoids is very clear, anoscopy is sufficient.