Hemorrhoids or Something Else


Hemorrhoids or Something Else — How to Determine?

Hemorrhoids are common and usually not too serious. They can often be treated with home remedies, and you may not even need to be seen by a doctor.

But some symptoms of hemorrhoids, especially rectal bleeding, may also be caused by other diseases, some of them serious, like colon cancer.

“Common hemorrhoid symptoms in someone who has been diagnosed with hemorrhoids in the past can be treated at home,” advises Jason F. Hall, MD, a colon and rectal surgeon at the Lahey Clinic in Burlington, Mass. “Any new rectal bleeding or heavy rectal bleeding, especially in someone over age 40, should be evaluated.”
Hemorrhoid symptoms may include finding bright red blood on your toilet paper or seeing blood in the toilet after a bowel movement. Other common symptoms include rectal pain, pressure, burning, and itching. You may also be able to feel a lump in your anal area.
All these symptoms are common for hemorrhoids, and 75 percent of people get hemorrhoids at some point. So how, then, do you know when it might be something else?

Determining the Diagnosis

When symptoms can be caused by more than one disease, doctors call it a differential diagnosis. Here are five different causes for hemorrhoid symptoms you need to know about:

  • Colon cancer and rectal cancer. “These cancers can occur near the rectum and cause bleeding and discomfort that are similar to hemorrhoid symptoms,” says Dr. Hall. “Rectal and colon cancer are rare before age 40.” Colon cancer symptoms may include persistent bleeding, a change in bowel habits or bowel movement shape, lower abdominal pain, and unexpected weight loss.
  • Inflammatory bowel disease (IBD). This condition, which Hall says includes ulcerative colitis and Crohn’s disease, can cause rectal bleeding and discomfort. Both types of IBD are long-term diseases that usually begin in young adults, he says. Symptoms may include cramps, diarrhea, weight loss, and fever.
  • Anal fissures. “Anal fissures are small tears, like paper cuts, in the anal canal that can act very much like hemorrhoids,” says Hall. Anal fissures can cause pain, burning, and bleeding. They can occur at any age and are usually caused by constipation. Anal fissures usually clear up with home treatments similar to those used for hemorrhoids.
  • Pruritis ani.“This condition is frequently mistaken for hemorrhoids because it causes itching and burning in the rectal area,” explains Hall. “It is actually a type of localized dermatitis.” Pruritis ani causes an intense urge to scratch. It may result from too much moisture or a food sensitivity. Treatment involves keeping the area dry, avoiding scrubbing, and using a prescription ointment or cream.
  • Genital warts.Genital warts are one of the many sexually transmitted diseases (STDs) that can grow in the anal area and cause symptoms of bleeding and discomfort. Genital warts are caused by human papilloma virus (HPV), and they should always be treated because they will continue to grow and increase the chances of getting rectal cancer. “Other STDs, including chlamydia and gonorrhea, can also occur in the anal area and cause symptoms of irritation and bleeding,” warns Hall.

Getting Help for Hemorrhoid Symptoms

You should seek treatment for hemorrhoid symptoms if:

  • You have rectal bleeding for the first time.
  • You have heavy rectal bleeding.
  • You have rectal bleeding that is not responding to home care.
  • You have other hemorrhoid symptoms, such as pain, pressure, itching, and burning, that do not respond to home care after a few days.
  • You have hemorrhoid symptoms along with other symptoms such as fever, weight loss, abdominal pain, or a change in bowel habits.

“Hemorrhoids are common, but hemorrhoids symptoms that do not clear up quickly with home care or that keep coming back do need to be evaluated,” Hall says. “The best place to start is with your primary caregiver. In many cases, a primary caregiver can make the right diagnosis and start you on the best treatment. If you need a diagnostic evaluation by a specialist, you may be sent to a gastroenterologist or a colon and rectal surgeon. If you need any surgical treatment, it should be done by a colon and rectal surgeon.”

Knowing the differential diagnosis of hemorrhoid symptoms can help you prevent a minor complaint from becoming a serious problem.

Hemorrhoids or Something Else — How to Determine?

If you’re experiencing severe rectal pain, you might think it’s hemorrhoids, but it could be something worse. Dr. Tom Miller and Dr. Bartley Pickron talk about how to distinguish between common hemorrhoids and more serious conditions. They also discuss treatments and relief for pain, as well as when to see a doctor.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I’m here today with Dr. Bartley Pickron and he is a surgeon in the department of surgery. He is also a specialist in colorectal surgery. It’s good to see you. I have patients that come to me and they ask, “I’ve got this pain in my bottom/rectum,” and they say, “I think I have a hemorrhoid.” How often is it a hemorrhoid or is it something else?

Dr. Pickron: Most of the patients we see for anorectal pain don’t have hemorrhoids, but everybody has hemorrhoids to some degree.

Dr. Miller: Most don’t.

Dr. Pickron: Most don’t, but the real causes of pain are more things like fissures, an abscess, and other things that aren’t hemorrhoids.

Dr. Miller: Fissures can be incredibly painful.

Dr. Pickron: They’re horrible.

Dr. Miller: What causes a fissure?

Dr. Pickron: Usually it’s a tear and it happens directly in the front or directly in the back. Most of the time these things heal up just fine, but if they don’t and they get deep enough to where the anal sphincter gets irritated . . .

Dr. Miller: Ouch.

Dr. Pickron: . . . then you get a spasm of that muscle and that prevents the tear from healing and then you just enter this vicious cycle that just won’t quit.

Dr. Miller: So you use different therapies to try to repair that.

Dr. Pickron: Yeah, generally we focus not so much on the tear but on the muscle itself because if we could make the muscle relax and stop the spasm then the tear generally heals just fine on its own.

Dr. Miller: While hemorrhoids aren’t the usual cause, as you pointed out, they’re both internal and external hemorrhoids, my understanding is that the external hemorrhoids can be painful.

Dr. Pickron: They certainly can. The most common thing we see when they are painful is a thrombosis, where you get a big blood clot with the pain and swelling.

Dr. Miller: Ouch. How do you treat that?

Dr. Pickron: Most of the time, we let them these reabsorb on their own. If patients come in within the first two or three days after the event happens, then there is some benefit to removing it surgically because they’ll get better faster, but usually once they’re kind of over the pain curve and their symptoms are getting better, then the pain and swelling will generally just take care of itself.

Dr. Miller: After you do the treatment, is there any kind of change in diet that they might need to make? My understanding is that constipation, straining, those things can contribute to external hemorrhoids. What’s your thought on that?

Dr. Pickron: Absolutely. Constipation and particularly straining or sitting on the toilet for a long time during bowel movements reading the magazine, for example, all tend to predispose people to hemorrhoids. We recommend a change in bowel habits, usually by the addition of fiber or stool softeners and staying hydrated.

Dr. Miller: When do you treat a fissure or hemorrhoids with a procedure?

Dr. Pickron: I’ll talk about the fissures first and probably maybe 10 or 20% of those are actually treated surgically. We have creams that we can use that generally take care of things. If that doesn’t work, Botox injection is an option. If those don’t work, then the last resort is certainly surgery.

Dr. Miller: So that’s treatment for fissures, how do you treat hemorrhoids?

Dr. Pickron: Again, most of these are treated non-operatively. There are procedures in the office we do. The most common thing we do is a procedure called rubber band ligation, where we put rubber bands around the hemorrhoids on the inside. That sounds pretty painful, but truthfully the internal hemorrhoids really have no sensation, so it’s a very easy procedure to do and very well tolerated. It’s usually just some mild pressure for about 24 hours and that’s it. The ones that do need to be treated surgically, like I said, are typically the external ones and those are, fortunately for patients, fairly rare.

Dr. Miller: It would seem to me to be rare, but are there times that the pain could be induced by something like a cancer?

Dr. Pickron: It is. That’s certainly one reason that these symptoms need to be evaluated very thoroughly.

Dr. Miller: So if they’re going on for weeks, that’s something that probably ought to be looked at?

Dr. Pickron: Right. So any combination of pain and bleeding and particularly if there is a little mass or something that just doesn’t feel right, then that absolutely needs to be checked out.

Dr. Miller: Any other causes of rectal pain? I know that there’s one that is a spasm that occurs from time to time in some people.

Dr. Pickron: Some people get this kind of vague rectal pain, which as you mentioned is just kind of a spasm, it’s fairly poorly understood. There are some options for it such as physical therapy, biofeedback, but these can be challenging things to treat.

Dr. Miller: It comes on suddenly and then goes away over seconds to minutes, I think, sometimes.

Dr. Pickron: Yeah, usually happens in the middle of the night. People kind of wake up and they feel this intense pressure almost like a Charley horse in their rectum, which not a pleasant sensation.

Dr. Miller: Any other causes of pain?

Dr. Pickron: Those are primarily the big ones, infections, abscesses are fairly common and those are typically treated with surgical drainage.

Hemorrhoids or Colon Cancer?

Colon cancer and hemorrhoids are very different conditions, but they can produce blood in the stool. Seeing blood in the stool can be alarming, especially if you have never experienced it before. Most likely, you may have been straining when having a bowel movement and the bleeding is due to a hemorrhoid. In other cases, blood in the stool could be an indication of something more serious. Let’s take a look at both hemorrhoids and colon cancer so you can be informed.

What Are Hemorrhoids?

Hemorrhoids are itching, painful or bleeding masses of swollen tissues and veins located in the anus and rectum. This results from congestion in the blood vessels around the anal canal. Hemorrhoids can be either internal (above the junction between the anus and rectum) or external (below the junction of the rectum and anus). About 89 percent of all Americans will experience hemorrhoids at some point in their lives, so they are much more common than you may think. Most hemorrhoids occur from an increase in pressure, often from straining to have a bowel movement. Hemorrhoids can also be caused by:

  • Pregnancy
  • Aging
  • Sitting for long periods of time
  • Chronic constipation or diarrhea
  • Straining
  • Lifiting objects that are too heavy

Symptoms of Hemorrhoids

Although the most common symptom of hemorrhoids is blood in the stool or blood on the toilet paper after wiping, there are other warning signs as well. Some other common symptoms of hemorrhoids are:

  • Irritation and itching
  • Pain or discomfort during bowel movements
  • Sensitive, painful lumps around the anus
  • Leakage of feces

Hemorrhoids can be completely painless, as with internal hemorrhoids, or they can be quite painful when they are outside the anus. Depending in your toilet habits, you can exacerbate irritation and cause more bleeding and itching. Excessive rubbing or cleaning of the affected area can just make it worse.

Reviewed by the QSota Medical Advisory Board