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When a patient complains of hemorrhoids, an anal fissure, or a small perianal polyp, the question often arises: “Why do I need a colonoscopy?” At first glance, it may seem unnecessary — the symptoms are “on the outside”, not inside the bowel. But that’s exactly where the mistake begins. Up to 20% of colorectal cancers may be completely asymptomatic. Early tumors can easily mimic benign conditions like hemorrhoids or fissures. Without a colonoscopy, we risk missing something serious. Colonoscopy helps us rule out cancer, detect polyps or chronic inflammation, and plan treatment in a safe and informed way. This is especially critical in patients over 45, or those with anemia, changes in stool, or a family history of colorectal cancer. That’s why even before “minor” proctologic procedures — like rubber band ligation or removal of anal polyps — a colonoscopy is essential. It’s not just a formality. It’s a standard of modern, evidence-based care. And a way to make sure we’re not treating symptoms while missing the real cause.