Introduction: Hematochezia is a common reason for consultation in gastroenterology. Hemorrhoidal disease is one of its primary causes; however, it can also manifest as a sign of other benign or malignant conditions of the colon. Aims: To determine the type and frequency of lesions observed during colonoscopy in patients with confirmed hemorrhoidal disease who are experiencing hematochezia. Methods: This was a retrospective, cross-sectional study conducted across three endoscopy centers in Brazzaville, including patients aged 18 years and older who underwent total colonoscopy between January 1, 2020 and December 31, 2024, for hematochezia. All patients had pathological hemorrhoids, confirmed either by endoscopy or clinically. The frequencies of coexisting rectal and colonic lesions were assessed. The Fisher’s exact test was employed to determine the association between age and sex with the main lesions observed during colonoscopy. Results: Between January 1, 2020, and December 31, 2024, 173 patients with hemorrhoidal disease underwent colonoscopy for hematochezia. The mean age was 48.8+/？12.9 years, with 76.4% being over the age of 40. The majority of patients (84.4%) were male. The most frequently observed lesions during colonoscopy were diverticula (15% of cases) and polyps (9.2% of cases). Patients over 60 years of age accounted for 50% of those with polyps and 53.8% of those with diverticula. A statistically significant association was found between age and the presence of diverticula (p < 0.001), as well as between age and the presence of a polyp (p = 0.04). Conclusion: Diverticula and polyps were the most common lesions identified. Total colonoscopy should be considered in patients with hematochezia even in the presence of hemorrhoidal disease, especially in those over 40 years.
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