Rectal bleeding often causes immediate concern, leading people to worry about serious diseases like colorectal cancer. The symptom of blood in the stool or on the toilet paper can be frightening. This fear is compounded because the most common cause, hemorrhoids, and a serious one, cancer, can share this symptom. This article clarifies the relationship between bleeding hemorrhoids and cancer and guides the reader on proper evaluation and management.
The Direct Answer: Hemorrhoids Do Not Cause Cancer
Hemorrhoids are a common condition, affecting the majority of adults, especially after age 50. They are swollen veins that develop in the anus and lower rectum, similar to varicose veins in the legs. These enlarged clusters of blood vessels are benign and are not a form of cancer.
There is no scientific evidence that hemorrhoid tissue can turn into cancerous tissue or that hemorrhoids directly cause colorectal cancer. Hemorrhoids develop due to increased pressure, often from straining during bowel movements, chronic constipation, or pregnancy. Colorectal cancer arises from abnormal cell growth, typically beginning as a small growth called a polyp on the lining of the colon or rectum.
Understanding Rectal Bleeding: Distinguishing Symptoms
Both hemorrhoids and colorectal cancer can cause rectal bleeding, leading to confusion. While characteristics of the bleeding can provide clues, self-diagnosis should always be avoided. Bleeding from hemorrhoids is typically bright red because the blood comes from vessels near the anal opening.
This bright red blood is usually noticed on the toilet paper, dripping into the toilet bowl, or streaking the surface of the stool. The bleeding is often painless or accompanied by mild discomfort, itching, or pain around the anus. Hemorrhoid symptoms are usually episodic, flaring up with straining or constipation and resolving with home care.
Bleeding associated with colorectal cancer may present differently, necessitating medical investigation. The blood may be darker red, sometimes mixed into the stool, or appear black and tarry if the source is higher up in the colon. Other symptoms signaling a serious issue include a persistent change in bowel habits, such as new constipation or diarrhea. Unexplained weight loss, persistent abdominal pain or cramping, a feeling of incomplete bowel emptying, and fatigue also warrant immediate attention.
When Bleeding Requires Medical Investigation
Any new or persistent rectal bleeding requires a medical evaluation, even if hemorrhoids are present. Relying on self-diagnosis is risky because a low-lying tumor can mimic hemorrhoids by bleeding bright red blood, and both conditions can coexist. A physician will conduct a thorough physical examination, including a digital rectal exam (DRE), to check for masses or irregularities.
To confirm the bleeding source and rule out cancer, several diagnostic tools may be used. A fecal occult blood test (FOBT) or fecal immunochemical test (FIT) can detect hidden blood in the stool, indicating bleeding higher in the digestive tract. The primary procedure is often a colonoscopy, which involves inserting a flexible tube with a camera to examine the entire colon and rectum.
A sigmoidoscopy may also be performed, which examines only the rectum and the lower part of the colon. These procedures allow the doctor to visualize the lining, identify the bleeding source, and remove any precancerous polyps. Screening is important for individuals over age 45 or those with risk factors, such as a family history of colorectal cancer, a personal history of polyps, or inflammatory bowel disease.
Managing Hemorrhoids
Once hemorrhoids are confirmed as the source of bleeding, the focus shifts to management and prevention. The primary goal of home treatment is to soften the stool and reduce straining during bowel movements, decreasing pressure on the rectal veins. This is achieved by incorporating high-fiber foods like whole grains, fruits, and vegetables into the diet, aiming for 20 to 35 grams of fiber daily.
Drinking sufficient water, typically six to eight glasses per day, is important to keep the stool soft and prevent constipation. Over-the-counter treatments provide symptomatic relief, including creams and suppositories containing hydrocortisone or witch hazel to ease pain and itching. Soaking the anal area in a warm bath, known as a sitz bath, for 10 to 15 minutes a few times a day can also soothe discomfort.
If symptoms persist despite these changes, a specialist may recommend minimally invasive procedures.
Minimally Invasive Procedures
Common in-office treatments include rubber band ligation, where a small band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off. Sclerotherapy involves injecting a chemical solution into the hemorrhoid to make it scar and shrink.