Is It Hemorrhoids or Something Else?
Rectal bleeding and discomfort are common symptoms of hemorrhoids, but of other conditions as well. Here's how to tell them apart.
By Chris Iliades, MD
Medically Reviewed by Pat F. Bass III, MD, MPH
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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.
Video: Stages Of Hemorrhoids | Grade 1 Hemorrhoids & Grade 2 Hemorrhoids
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