Background: Hemorrhoids are swollen veins of the hemorrhoidal plexus that are normally present in the anal canal. Clinically detectable if the supporting connective tissue is compromised. In this study, we focused on the effectiveness and importance of colonoscopy for studying the prevalence of internal hemorrhoids. Objective: The study aimed to evaluate the prevalence of internal hemorrhoids in patients undergoing colonoscopy for different indications. Patients and Methods: This cross-sectional study was conducted in the Elective Gastrointestinal Endoscopy Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University. The study was conducted through the period from March 2021 to Augustus 2021, and including 300 consecutive Egyptian patients who underwent a flexible colonoscopy for different reasons. Results: In the present study, we revealed that hemorrhoids increasing with aging. The diagnostic results were internal hemorrhoids (38.3%), colonic ulcers (11%), inflammatory lesions (7.3%) and mass (7%), diverticular disease (6%), polyps (5.7%), and vascular malformations (1.3%). The complaints of the patients were lower GI bleeding (41.7%). Chronic diarrhea (17.7%), abdominal pain (14.7%), and chronic constipation (13.3%) in the subsequent levels. Also, chronic anemia (6.7%), follow-up colon polyp (5.3%), one patient had weight loss (0.3%) and one patient had anal pain (0.3%). Conclusions: We can conclude a wide prevalence of internal hemorrhoids in patients who underwent colonoscopy for various reasons. Besides, retroflexed colonoscopy can contribute to the study of the prevalence of internal hemorrhoids because it can diagnose even asymptomatic hemorrhoids. In addition, colonoscopy was found to be extremely safe and no complication was detected.