What to know about bleeding hemorrhoids

Most often, internal hemorrhoids have no symptoms but are only found if there is bleeding with a bowel movement or if the hemorrhoid prolapses so that it can be felt outside of the anus. This may lead to itching and pain as well as the bleeding. Hemorrhoids also may cause anal itching (pruritus ani), and a constant feeling of needing to have a bowel movement (tenesmus).

Colon Cancer vs. Hemorrhoid Symptoms

Colon cancer is the transformation of normal cells to abnormal cells in the colon. Most colon cancers are adenocarcinomas-tumors that develop from the glands lining the colon’s inner wall.

Left untreated, these cancers grow and eventually spread through the colon wall to involve the adjacent lymph nodes and organs. Ultimately, they spread (metastasized) to distant organs such as the liver, lungs, brain, and bones.

Sometimes colon cancer, or malignant tumors, are referred to as colorectal cancer, reflecting the fact that the rectum, the end portion of the colon, also can be affected. Some researchers and doctors recognize colon and rectal cancer to be two different types of cancer in the digestive tract, due to the anatomical differences in the rectum as compared to the rest of the colon.

• One in 17 people in the U.S. will develop colorectal cancer.
• According to reports from the National Cancer Institute, colorectal cancer is the third most common cancer in U.S. men.
• Colorectal cancer is the second most common cancer in U.S. women of Hispanic, American Indian/Alaska Native, or Asian/Pacific Islander ancestry, and the third most common cancer in white and African American women.
• Deaths from colorectal cancer rank third after lung and prostate cancer for men and third after lung and breast cancer for women.
• Death statistics from colon cancer vs. rectal cancer is not clear as an estimated 40% of rectal cancers are misdiagnosed as colon cancer.

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SLIDESHOW

What Are Hemorrhoids? What Do Hemorrhoids Look Like?

Picture of Internal, External, and Thrombosed Hemorrhoids

Hemorrhoids are enlarged and swollen blood vessels located in the lower part of the rectum and the anus. The blood vessels become swollen due to increased pressure within them. There are different types of hemorrhoids.

1. Internal hemorrhoids are located on the inside lining of the rectum and cannot be felt unless they prolapse and push through the anus opening causing pain and itching.
2. External hemorrhoids are located beneath the skin on the outer aspect of the anus. Symptoms may include bleeding with a bowel movement and a mass or fullness that can be felt at the anal opening. External hemorrhoids do not cause many problems unless they rapidly expand and clot. Usually this clot resolves spontaneously leaving residual skin.
3. A thrombosed external hemorrhoid occurs when blood within the blood vessel clots, and may cause significant pain and swelling.

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What Are the Differences Between Colon Cancer and Hemorrhoid Symptoms and Signs?

Colon Cancer Symptoms and Signs

People commonly attribute all rectal bleeding to hemorrhoids, thus preventing early diagnosis owing to lack of concern over “bleeding hemorrhoids.” New onset of bright red blood in the stool always deserves an evaluation. Blood in the stool may be less evident, and is sometimes invisible, or causes a black or tarry stool.

• Rectal bleeding may be hidden and chronic and may only show up as an iron deficiency anemia.
• It may be associated with fatigue and pale skin due to the anemia.
• Changes in bowel movement frequency
• It usually, but not always, can be detected through a fecal occult (hidden) blood test, in which samples of stool are submitted to a lab for detection of blood.
• If the tumor gets large enough, it may completely or partially block your colon. You may notice the following symptoms of bowel obstruction:
• Abdominal distension: Your belly sticks out more than it did before without weight gain.
• Abdominal pain: This is rare in colon cancer. One cause is tearing (perforation) of the bowel. Leaking of bowel contents into the pelvis can cause inflammation (peritonitis) and infection.
• Unexplained, persistent nausea or vomiting
• Unexplained weight loss
• Change in frequency or character of stool (bowel movements)
• Small-caliber (narrow) or ribbon-like stools
• Constipation
• Sensation of incomplete evacuation after a bowel movement
• Rectal pain: Pain rarely occurs with colon cancer and usually indicates a bulky tumor in the rectum that may invade surrounding tissue after moving through the colon’s submucosa.

Research suggests that the diagnosis of colon cancer is about 3 ½ months after signs and symptoms begin.

Symptoms and Signs of Hemorrhoids

The most common signs and symptom is painless bleeding. There may be bright red blood on the outside of the stools, on the toilet paper, or dripping into the toilet. The bleeding usually is self-limiting. Symptoms may depend upon the type of hemorrhoid.

Internal Hemorrhoid Symptoms and Signs

Most often, internal hemorrhoids have no symptoms but are only found if there is bleeding with a bowel movement or if the hemorrhoid prolapses so that it can be felt outside of the anus. This may lead to itching and pain as well as the bleeding. Hemorrhoids also may cause anal itching (pruritus ani), and a constant feeling of needing to have a bowel movement (tenesmus).

Prolapse of an internal hemorrhoid occurs when the internal hemorrhoids swell and extend from their location in the rectum through the anus. A prolapsed internal hemorrhoid:

• A lump can be felt outside of the anus
• Can be gently pushed back through the anus, this may resolve the location of the hemorrhoid, but does not fix the hemorrhoid itself.
• May enlarge and swell even more if it cannot be pushed back
• May become entrapped, which requires more urgent medical attention

External and Thrombosed Hemorrhoid Symptoms and Signs

Thrombosed external hemorrhoids are a painful condition. These occurs when a blood clot develops in a hemorrhoidal blood vessel causing swelling and inflammation.
When a blood clot occurs in a hemorrhoid, the hemorrhoid will become even more swollen. This swelling leads to increased pain. The pain is usually worse with bowel movements and may increase with sitting.

A thrombosed external hemorrhoid may resolve on its own; however, this condition often needs medical care. Bleeding with a bowel movement is never normal and should prompt a visit to a health care professional. While hemorrhoids are the most common cause of bleeding with a bowel movement, there may be other reasons for bleeding including inflammatory bowel disease, infection, and tumors.

What Causes Colon Cancer and Hemorrhoids? Do Hemorroids Lead to Colon Cancer?

Colon Cancer Causes

Most colorectal cancers arise from adenomatous polyps. Such polyps are comprised of excess numbers of both normal and abnormal appearing cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.

People with certain genetic abnormalities develop what are known as familial adenomatous polyposis syndromes. Such people have a greater-than-normal risk of colorectal cancer. In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.

• There are specific genetic abnormalities found in the two main forms of familial adenomatous polyposis.
• The cancer usually occurs before age 40 years.
• Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After six months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.

Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also runs in families. In these syndromes, colon cancer develops without the precursor polyps.

• HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
• Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.

HNPCC syndromes are sometimes linked to tumors in other parts of the body.

Other high risk factors for developing colon cancers include any one of the following:

• Ulcerative colitis or Crohn’s colitis (Crohn’s disease)
• Breast, uterine, or ovarian cancer now or in the past
• A family history of colon cancer

The risk of colon cancer increases two to three times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.

Other factors that may affect your risk of developing a colon cancer include:

• Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
• Obesity: Obesity has been identified as a risk factor for colon cancer.
• Smoking:Cigarettesmoking has been definitely linked to a higher risk for colon cancer.
• Drug effects: Recent studies have suggested postmenopausal hormone estrogen replacement therapy may reduce colorectal cancer risk by one-third. Patients with a certain gene that codes for high levels of a hormone called 15-PGDH may have their risk of colorectal cancer reduced by one-half with the use of aspirin.

Causes of Hemorrhoids

Hemorrhoids are not arteries or veins, but instead are normal blood vessels called sinusoids that are located in the walls that surround the rectum and anus. When the venous pressure within these blood vessels increases, the hemorrhoids swell and dilate, because it is more difficult for blood to empty from them. This leads to the most common symptoms of bleeding and swelling.

Common situations that increase pressure within the hemorrhoidal blood vessels and lead to abnormalities include:

• Colon cancers
• Straining to have a bowel movement. This may be due to constipation or diarrhea.
• Prolonged sitting, including on the toilet
• Lack of exercise
• Low fiber diet
• Obesity
• Pregnancy
• Liver disease
• Inflammatory bowel disease
• Anal intercourse
• Spinal cord injury

What Should I Do If I Have Signs and Symptoms of Colon Cancer or Hemorrhoids?

When to Call the Doctor for Colon Cancer Symptoms and Signs

If you have any of these symptoms call a doctor.

• Bright red blood on the toilet paper, in the toilet bowl, or in your stool when you have a bowel movement
• Change in the character or frequency of your bowel movements
• Sensation of incomplete evacuation after a bowel movement
• Unexplained or persistent abdominal pain or distension
• Unexplained weight loss
• Unexplained, persistent nausea or vomiting

If you have any of these symptoms, go to the nearest hospital Emergency Department.

• Large amounts of bleeding from your rectum, especially if associated with sudden weakness or dizziness
• Unexplained severe pain in your belly or pelvis (groin area)
• Vomiting and inability to keep fluids down

When to Call the Doctor for Hemorrhoid Symptoms and Signs

Bleeding from the rectum or anus is never normal and although hemorrhoids are the most common reason to have blood in the stool. If you have rectal bleeding or blood in your stool, call a doctor. Other causes of rectal bleeding exist and can be serious. Inflammatory bowel disease and cancers of the colon can cause with rectal bleeding. Blood in the stool should never be ignored.

• Seek medical care immediately if you take anticoagulation medications such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxiban (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), prasugrel (Effient) or enoxaparin (Lovenox).
• People who have associated symptoms such as lightheadedness and weakness may have significant blood loss and may require more urgent care.
• Abdominal pain. Hemorrhoids do not cause abdominal pain.
• Prolapsed hemorrhoids that cannot be pushed back through the anus.
• Thrombosed external hemorrhoids may cause significant pain, and a doctor may need to remove the clot.

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Rectal Cancer Symptoms vs. Hemorrhoids

Rectal cancer and hemorrhoids both cause rectal bleeding. Signs and symptoms of rectal cancer that do not occur with hemorrhoids are unexplained weight loss without dieting, bowel obstruction, anemia, constipation, and fatigue. Hemorrhoids can cause itching and pain around the anal area, which are not symptoms of rectal cancer. Rectal cancer can cause hemorrhoids due to prolonged sitting and straining while trying to have a bowel movement due to constipation or severe diarrhea. Hemorrhoids do not cause rectal cancer; however, they may be lead to colon cancer.

Reviewed on 8/10/2022
References

Image source: iStock Images

“Clinical presentation, diagnosis, and staging of colorectal cancer.” UpToDate.com

“Colorectal Cancer: Epidemiology, risk factors, and protective factors.” UpToDate.com

“Colorectal Cancer Statistics, 2017.” American Cancer Society. May 1, 2017. .

“Overview of the management of primary colon cancer.” UpToDate.com

Rakel, R.E., and D. Rakel. Textbook of Family Medicine, 9th Edition. Saunders, 2015.

Patient Comments & Reviews

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• Colon Cancer vs. Hemorrhoids – Symptoms and Signs What were your signs and symptoms of colon cancer or hemorrhoids? PostView 1 Comment
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What to know about bleeding hemorrhoids

Hemorrhoids are swollen blood vessels in and around the anus and rectum. Passing a small amount of bright red blood with stool is often the only sign that a person has hemorrhoids.

Straining during a bowel movement is the main reason for bleeding hemorrhoids. Other triggers include diarrhea or constipation and sitting or standing for a long time. They can also happen during pregnancy or after lifting a heavy item.

Signs of bleeding hemorrhoids include bright, red blood staining the toilet paper or feces.

Most people can treat hemorrhoids at home. In more severe cases, surgery may be necessary.

In this article, we look at why hemorrhoids bleed and what symptoms to look for. We also provide information on home remedies, medical treatments, and when to see a doctor.

Everyone has hemorrhoidal tissue inside their anal canals. It consists of blood vessels, connective tissue, and muscle.

When a person strains, sneezes, or exerts themselves, hemorrhoidal tissue swells to prevent feces from leaving the body. In most cases, the tissue returns to its usual size, but sometimes, it remains enlarged. When this happens, the enlarged tissue can form hemorrhoids.

• after a bowel movement, especially if there is straining
• with diarrhea or constipation
• after sitting or standing for a long time
• during pregnancy
• when lifting a heavy object
• if a blood clot blocks the blood supply, leading to ulceration and dead tissue

Hemorrhoids often remain inside the anal canal, but sometimes they bulge outward from the anus and become visible outside of the body. Either type can bleed, but only external ones are painful.

If hemorrhoids bleed, a person may see traces or streaks of bright, red blood:

• on tissues after wiping
• in the toilet bowl
• in the stool

If the blood is dark red, the person should notify a doctor as this can indicate a problem higher up in the gastrointestinal tract.

Thrombosed hemorrhoid

A thrombosed hemorrhoid is when a blood clot develops within the hemorrhoid.

As the swelling increases, pressure from surrounding tissues or stool can cause the hemorrhoid to rupture and bleed, often at the end of a bowel movement. This can lead to significant bleeding. There may also be severe pain.

A person should seek medical help at once if they notice :

• severe pain
• constant bleeding from the hemorrhoid
• more than a few drops of blood in the toilet bowl, perhaps with blood clots
• a bluish lump on the anus, suggesting a thrombosed hemorrhoid

Anyone with severe bleeding should seek medical help at once.

A thrombosed hemorrhoid also needs urgent treatment. Without treatment, thrombosed hemorrhoids can compress and damage the blood vessels in surrounding, healthy tissues.

If a person has symptoms of hemorrhoids that do not improve after 7 days, they should see a doctor.

Medical treatments for bleeding hemorrhoids will depend on the severity of symptoms, the size of the hemorrhoids, and whether the person has already tried other treatment options.

The following are some treatment options that may take place in a doctor’s office:

• Rubber band ligation involves placing a small band at the base of an internal hemorrhoid to cut off its blood supply. Hemorrhoids will usually fall off around 5–7 days later.
• Sclerotherapy involves injecting chemicals into the hemorrhoid to make it shrink. Scarring occurs in the blood vessels, stopping blood from flowing through them.
• Cryotherapy freezes the blood vessels, scarring the tissue and blocking the blood flow.
• Infrared photocoagulation uses a laser to damage hemorrhoidal tissue, causing it to shrink and slough off.

If a person has large or bulky hemorrhoids or other treatments have not helped, more invasive surgery may be necessary, such as:

• Hemorrhoidectomy: The doctor will numb the area with a local anesthetic, then cut the hemorrhoid away. For large hemorrhoids, a person may need general anesthesia.
• Stapled hemorrhoidectomy: The doctor will staple the hemorrhoids back inside of the anus.
• Hemorrhoid artery ligation: The doctor stitches the arteries that supply blood to the hemorrhoid, and it shrinks.

All these procedures aim to tie off the bleeding blood vessels so that they no longer bleed.

Home remedies cannot resolve bleeding hemorrhoids, but they can help relieve hemorrhoids and their symptoms.

Here are some home remedies to relieve discomfort and reduce the risk of further bleeding:

Sitz bath

A sitz bath is a small plastic tub that fits over the toilet seat. Filling it with warm water, around 104°F or 40°C, and sitting in it for up to 15 minutes can help maintain hygiene and relieve pain and irritation. Do not add anything to the water.

Ice

Applying ice packs or ice covered with a cloth to swollen areas can help reduce hemorrhoid pain and inflammation.

Good toilet habits

Toilet habits that can help include:

• using the bathroom when the person feels an urge to go, without delay
• avoiding excessive straining or pushing
• limiting time on the toilet to 3–5 minutes
• avoiding excessive wiping

Water

If a person increases their water intake, it may help soften their stool, making it easier to pass. Less straining during bowel movements gives hemorrhoids a chance to heal.

Experts recommend a daily water intake of 64 fluid ounces or more for people with hemorrhoids.

• creams or suppositories containing steroids, which reduce inflammation
• bulk-forming agents that work best when a person takes them in the morning and drinks plenty of fluids during the day
• stool softeners, which may contain polyethylene glycol or docusate
• rectal ointments containing witch hazel

Bleeding hemorrhoids often happen when a person strains when passing stool. Maintaining regular bowel movements can help prevent both hemorrhoids and bleeding. Other preventative measures include:

• increasing fiber intake
• drinking plenty of water
• exercising

Most cases of hemorrhoids resolve with conservative treatment, such as home remedies and OTC medications. Internal hemorrhoids have a 10–50% chance of returning in the next 5 years, but less than 5% after surgery. The chance of external hemorrhoids recurring after conservative treatment is over 50% , but only 5–10% after surgery.

Possible complications of both types of hemorrhoids and surgery include :

• infection
• thrombosis, where a blood clot forms
• incontinence

Following surgery, there is also a 30–50% chance of urinary retention.

Bleeding hemorrhoids can cause concern, but they do not always need medical intervention. If bleeding is heavy or persistent, however, or there is severe pain, a person should contact a doctor.

Adopting a high fiber diet and drinking plenty of water can help reduce the risk of hemorrhoids and bleeding.

A person should see a doctor if they have concerns about hemorrhoid symptoms, there is persistent or heavy bleeding, or they notice dark, red blood. The doctor will discuss treatment options with them and may carry out tests to rule out other conditions.

Here are some questions people often ask about bleeding hemorrhoids.

How do you treat a bleeding hemorrhoid?

To relieve discomfort, a person can take a sitz bath or apply ice wrapped in a cloth. OTC options can also help reduce inflammation and soften stool. Consuming plenty of water and fiber can help improve bowel movements and reduce the risk of straining, making hemorrhoids less likely to bleed.

Are bleeding hemorrhoids serious?

In most cases, occasional spotting with bright, red blood is not serious. However, if bleeding continues, there is severe pain, or the blood is dark red, a person should see a doctor, as these may be signs of a more serious condition.

Should I go to a doctor for bleeding hemorrhoids?

A person should see a doctor at once if bleeding is persistent or there is a lot of blood, which may include blood clots. They should also seek help if they notice dark, red blood, which can be a sign of problems in the stomach or intestines.

How long does it take for a bleeding hemorrhoid to heal?

This will depend on the individual, but if it persists longer than a week or the person is unsure why it is happening, they should see a doctor.

Last medically reviewed on April 27, 2022

• Constipation
• GastroIntestinal / Gastroenterology