ABSTRACT Background: Rectal bleeding in patients with hemorrhoids requires exact diagnosis because it may be not simply a hemorrhoidal bleeding and can be an early sign of severe bowel diseases, such as colon carcinoma, or inflammatory bowel diseases that could be discovered by colonoscopy. The present study was thus conducted to assess the role of preoperative colonoscopy in patients with haemorrhoids. Material and Methods: Present study was prospective, observational study, conducted in patients of age > 18 years, either gender, clinically diagnosed with haemorrhoids, underwent colonoscopic evaluation. Results: In present study, out of 50 cases of hemorrhoids, most common age group affected was between 41-60 years of age (64 %) with mean age of 48.32 ± 10.16 years. Male predominance was seen in present study with 64% males to 34% females. Male to female ratio being 1.78:1. Most common presenting complaint was bleeding (86%) followed by constipation (72%) and pain (18%). On colonoscopy examination, grade I and II haemorrhoids were seen in 28% cases while grade III and IV were observed in 48% and 24% cases respectively. Associated pathologies were reported in 30% cases with benign conditions in 22% and malignant condition in remaining 8% cases. Benign pathologies include: ulcerative colitis (10%), polyp (10%) and rectal ulcer (2%) while colorectal carcinoma was seen in 8% cases. Only 1 patient complained of pain after the procedure while bleeding was not reported in any case. Conclusion: Rectal bleeding warrants a complete colonic investigation, preferably by total colonoscopy. Avoiding colonoscopy in these patients can lead to missed-diagnosis or delay in diagnosis.