Rectal symptoms like discomfort, bleeding, or changes in bowel habits can stem from various conditions. While hemorrhoids are a common and often benign cause, these signs can also indicate a more serious issue like colorectal cancer. Understanding the differences between these conditions is important for seeking appropriate medical attention. This article clarifies the symptoms associated with both hemorrhoids and colorectal cancer, guiding individuals on when professional medical advice is necessary.
Common Signs of Hemorrhoids
Hemorrhoids are swollen veins located in the rectum or around the anus, similar to varicose veins that can appear elsewhere in the body. They are a common condition, affecting approximately half of all people by age 50. Hemorrhoids can be internal, forming inside the rectum, or external, developing under the skin around the anus. External hemorrhoids are often noticeable as itchy or painful lumps around the anal opening.
Internal hemorrhoids typically do not cause pain unless they prolapse, meaning they bulge outside the anus. The most common symptom of internal hemorrhoids is bright red blood appearing on toilet paper, in the toilet bowl, or on the surface of stool after a bowel movement. Other symptoms include anal itching, irritation, and a feeling of discomfort or swelling around the anus. These symptoms often fluctuate and are frequently associated with straining during bowel movements, chronic constipation, or diarrhea.
Common Signs of Colorectal Cancer
Colorectal cancer originates in the colon or rectum, typically developing from precancerous growths called polyps. In its early stages, colorectal cancer may not present any symptoms, which underscores the importance of regular screening. As the disease progresses, various signs may emerge, some of which can overlap with those of hemorrhoids. These include rectal bleeding and changes in bowel habits.
Other symptoms more indicative of colorectal cancer involve persistent changes in bowel frequency or consistency, such as new-onset diarrhea or constipation that does not resolve. Individuals might also notice stools that are narrower than usual or a persistent feeling that the bowel does not empty completely after a bowel movement. Unexplained weight loss, ongoing fatigue, abdominal pain, or cramping can also accompany colorectal cancer. These symptoms tend to be persistent and may worsen over time.
Key Distinctions in Symptoms
Distinguishing between hemorrhoid and colorectal cancer symptoms requires careful attention to their nature, persistence, and accompanying signs. Rectal bleeding is a shared symptom, but its characteristics often differ. Hemorrhoid-related bleeding is typically bright red, painless, and occurs during or immediately after a bowel movement, often seen on toilet paper or dripping into the toilet. In contrast, bleeding from colorectal cancer can vary in color, from bright red to darker hues, may be mixed within the stool (appearing black or tarry), and can occur at any time, tending to be more persistent.
Changes in bowel habits with hemorrhoids are usually intermittent and linked to factors like straining or diet. Colorectal cancer, however, can cause persistent, unexplained changes in bowel patterns, such as a lasting shift between diarrhea and constipation.
While hemorrhoids generally do not cause systemic symptoms, colorectal cancer can present with broader effects. Unexplained weight loss, fatigue, or weakness are not typical of hemorrhoids but can indicate colorectal cancer. Abdominal pain or cramping, especially if persistent and not relieved by bowel movements, is also more commonly associated with colorectal cancer. Lumps around the anus can occur with both, but a cancerous lump may be firmer and not easily reducible.
When to Seek Professional Medical Advice
Given the symptom overlap, always seek professional medical advice for any new or concerning rectal symptoms. Self-diagnosis is unreliable and can delay identifying a serious condition. Persistent rectal bleeding, regardless of its characteristics, warrants medical evaluation, even if minor, as it could signal an underlying problem.
Specific “red flag” symptoms requiring prompt medical attention include unexplained changes in bowel habits lasting more than a few weeks (e.g., persistent diarrhea, constipation, or unusually narrow stools). Unexplained weight loss, ongoing abdominal pain, or persistent fatigue interfering with daily activities also necessitate a doctor’s visit. Seek immediate medical attention for heavy or continuous rectal bleeding, or if accompanied by severe abdominal pain, dizziness, confusion, or fainting.
The Medical Diagnostic Process
When consulting a doctor for these symptoms, the diagnostic process typically begins with a thorough medical history and a physical examination. This often includes a digital rectal exam (DRE), where the doctor inserts a gloved, lubricated finger into the rectum to feel for abnormalities or external hemorrhoids. While a DRE can detect some issues, it cannot visualize the entire colon.
Further diagnostic steps may involve stool tests, which check for hidden (occult) blood that is not visible to the naked eye. Two common types are the guaiac-based fecal occult blood test (gFOBT) and the fecal immunochemical test (FIT). A stool DNA test, such as Cologuard, is another option that looks for genetic changes associated with cancer cells in addition to blood. If these tests are positive, or if symptoms are concerning, a more direct visualization of the colon is usually recommended.
Endoscopic procedures, such as a flexible sigmoidoscopy or a colonoscopy, allow a doctor to visually examine the lining of the colon and rectum. A sigmoidoscopy views the lower part of the colon, while a colonoscopy examines the entire large intestine. During these procedures, tissue samples (biopsies) can be taken from any suspicious areas for laboratory analysis, which helps to definitively diagnose conditions like cancer or inflammatory bowel disease. These tests are crucial for an accurate diagnosis and to determine the appropriate course of action.