Is It Hemorrhoids or Something Else?

Hemorrhoids can be uncomfortable, but they’re usually not serious. However, the symptoms of other, more serious health conditions can be mistaken for hemorrhoid symptoms. For instance, rectal bleeding is a sign of hemorrhoids but also a sign of colorectal cancer.

For this reason, you should always see a doctor if you have anal or rectal bleeding, pain, itching, a lump in these areas, or all of these symptoms.

“Hemorrhoids are part of being human and play an important role in continence,” says Kinga Skowron Olortegui, MD, a colorectal surgeon and assistant professor at UChicago Medicine in Chicago.

• Anal itching
• One or more tender lumps near the anus
• Aching or pain around the anus, especially when seated
• Bright red blood on toilet paper or in the toilet bowl
• One or more lumps outside your anus (in the case of a prolapsed hemorrhoid)

They’re not usually life-threatening but can mask more serious health issues with similar symptoms.

“If patients have pain or bleeding after their bowel movements have normalized, they should have it checked by a doctor,” Dr. Olortegui says.

To help understand whether you’re likely to have hemorrhoids or something else, it’s helpful to know about other conditions that can have similar symptoms.

Colorectal or Anal Cancer

“If there’s bleeding or a bump that’s growing, we want to check for cancer,” says Olortegui.

These cancers can occur near the rectum and cause bleeding and discomfort similar to hemorrhoid symptoms.

• A change in bowel habits or bowel movement shape
• The urge to complete a bowel movement but an inability to actually have one
• Abdominal pain or cramping
• Bright red bleeding from the rectum
• Blood in stool that makes it look dark or black
• Unexpected weight loss
• Weakness and fatigue

• Bleeding from the anus or rectum
• Itching
• A lump in the area
• Changes in bowel movements or shape
• Feeling of fullness in the anus or rectum
• Loss of bowel control
• Swollen lymph nodes in the groin

If you have any of these symptoms, be sure to see a doctor.

Inflammatory Bowel Disease (IBD)

• Blood in your stool
• Abdominal pain and cramping
• Diarrhea and other changes in bowel habits
• Weight loss
• Nausea
• Fatigue
• Nutritional deficiencies, if your gastrointestinal tract (GI) can’t absorb nutrients effectively

With IBD, symptoms tend to worsen during a flare, then subside during times of remission.

Ami Patel, MD, a board-certified gastroenterologist at Duke Health who’s based in Apex, North Carolina, says that both Crohn’s and UC can cause rectal bleeding similar to that seen with hemorrhoids.

“However,” she says, “IBD causes inflammation within the digestive tract, which commonly also presents with other symptoms, including diarrhea, abdominal pain, and weight loss.”

Plus, the color of the blood may differ with each condition, depending on where the bleeding happens, says Kenneth Josovitz, MD, MPH, a board-certified gastroenterologist based in Glen Allen, Virginia.

“IBD can cause bright red blood from the rectum or anus, especially with active disease or disease in the lower colon or rectum,” he says. “Darker blood or stool mixed with blood in IBD may be a sign of bleeding from higher in the GI tract.”

However, Crohn's can cause fissures, abscesses, or fistulas that can lead to bright red blood from the anus or rectum, Dr. Josovitz says.

In other words, though bright red blood can indicate either hemorrhoids or IBD, darker blood is unlikely to be due to hemorrhoids.

Anal Fissures

“Anal fissures are small tears, like paper cuts, in the anal canal that can act very much like hemorrhoids,” says colorectal surgeon Jason Hall, MD, MPH, chair and surgeon-in-chief of the department of surgery at Tufts Medical Center in Boston.

• Sharp pain, burning, or itching during a bowel movement
• Bright red blood in your stool
• Muscle spasms in your anus
• A lump on the skin near the fissure

Perianal Abscess

• Rectal bleeding
• Irritation or itching around the anus
• A pus-like discharge from your anus
• Anal or rectal pain, which may be severe or constantly throbbing
• A red, swollen, painful bump
• Pain in your lower abdomen

It’s important to see a doctor if you think you may have a perianal abscess.

“A perianal abscess almost always needs medical intervention,” Josovitz says. Without treatment, “an abscess can worsen and spread to deeper tissues, lead to systemic infection or sepsis, and even lead to a fistula,” he says.

Home treatment can help relieve symptoms but won’t solve the underlying problem, which is the infection, Josovitz says.

“While some abscesses can be treated with warm compresses and sitz baths, you should see your healthcare provider to determine whether they need to open and drain the abscess,” Dr. Patel says.

Never drain an abscess at home, as it could lead to complications such as a worse infection, she says. Always let a doctor drain your abscess. Afterward, they may prescribe antibiotics.

Pruritis Ani

The term “pruritus” means itching, and pruritus ani causes an intense urge to scratch your anus.

“Also known as anal itching, it’s easily mistaken for hemorrhoids, but it’s just an itch that often clears up with some dietary changes,” says Olortegui. “It’s often triggered by spicy or acidic foods.”

• Too much moisture around the anus
• Irritated skin, such as from wiping or a reaction to hygiene products
• Incomplete wiping after a bowel movement
• Constipation or diarrhea
• Certain foods, such as dairy or carbonated beverages

An infection, skin conditions, irritants, or other medical conditions can also cause anal itching, Patel says.

Whatever the cause, avoid scratching, which can lead to bleeding if it aggravates any underlying hemorrhoids or anal fissures, Josovitz says.

• Keep the area clear and dry.
• Avoid harsh scrubbing and perfumed hygiene products.
• Opt for underwear with good moisture protection and a snug but full fit.
• Try cutting out potentially irritating foods, such as tomatoes and citrus.
• Avoid drinking alcohol.
• Ask your pharmacist about over-the-counter creams that can help.

If you have unusual itching and you don’t know why, speak with a doctor. They can help you find out whether it’s from hemorrhoids or another cause.

Pinworms

You can pass on pinworms if you get the eggs under your fingernails while scratching the area around your anus. If you then don’t wash your hands and the eggs get onto food, for instance, they can enter another person’s body through their mouth.

Anal Warts

• Bumps or raised growths on the skin around the anus
• Light brown, yellow, pink, or flesh-colored bumps that may cluster
• Itching
• Bleeding
• A discharge of mucus

Anal warts and hemorrhoids can feel similar if you touch them, as they both feel like a lump near the anus, Patel says.

On closer inspection, however, hemorrhoids are “firm, rubbery, and bulging and can be painful,” Josovitz says, while anal warts are “soft, fleshy, and ‘cauliflower-like.’” Warts are usually painless, and they don’t usually bleed, he says.

“Given the importance of accurate diagnosis, it is important that a healthcare professional evaluate any new anal lesion,” Patel says.

• New rectal bleeding
• Severe or persistent pain
• Blood in your stool
• Changes in bowel habits
• Changes in stool color or consistency
• Symptoms that haven’t responded after a week of home care or over-the-counter remedies
• Severe rectal bleeding, possibly with faintness or dizziness
• Fever, weight loss, abdominal pain, or other symptoms
• A lump that is new or seems to be growing
• Discharge in the anal area
• Anal pain that doesn’t go away within 24 to 48 hours

• Severe pain
• Swelling
• Inflammation
• A hard, discolored lump near your anus

These can be signs of a thrombosed hemorrhoid, when a clot forms in a hemorrhoid.

Depending on your symptoms and risk factors, they may also do a colonoscopy and other tests to rule out other conditions with similar symptoms.

• Hemorrhoids are a common health issue that cause swollen veins around the rectum and anus, resulting in pain, itching, discomfort, and bleeding.
• Hemorrhoids aren’t usually serious and often respond to home or over-the-counter treatment.
• The symptoms of colorectal cancer and other conditions can sometimes be mistaken for hemorrhoids.
• If symptoms are bothersome, ongoing, or include changes in bowel habits, it’s best to see a gastroenterologist. They can help you find effective treatment and rule out other, more serious illnesses with similar symptoms.