Hemorrhoids or Something Else? Colon Cancer, Fissures and Other Look-alikes

What else causes rectal bleeding, pain, and itching?

Hemorrhoids are the most common cause of rectal bleeding, but they are not the only one. Anal fissures, abscesses and fistulas, chronic anal itching, inflammatory bowel disease, diverticular bleeding, colon polyps, and colorectal cancer can all produce symptoms that feel exactly like hemorrhoids. Part of why the two get confused so often is simply how common hemorrhoids are: about half of adults in the United States have symptomatic hemorrhoids by around age 50, so when bleeding or discomfort shows up, hemorrhoids are the natural first guess, even when something else is going on. That is the reason an exam comes before treatment at Digestive & Liver Center of Arkansas in Fort Smith. Assuming that blood on the toilet paper is "just hemorrhoids" is one of the most common, and occasionally most costly, mistakes patients make. A quick way to think about the bleeding itself: bright red blood on the paper or in the bowl, during or right after a bowel movement, is typical of hemorrhoids or a fissure. Blood that is dark or maroon, mixed into the stool, or unrelated to a bowel movement points toward a cause elsewhere in the digestive tract. Either pattern can still turn out to be hemorrhoids, and either can turn out not to be, which is why an exam settles it, not the color alone.

Anal fissures

An anal fissure is a small tear in the lining of the anal canal, and it is the condition most often mistaken for hemorrhoids. The giveaway is pain: a fissure typically causes a sharp, tearing, knife-like pain during a bowel movement that can linger for minutes to hours afterward, often with a streak of bright red blood. Fissures are usually caused by hard stools, straining, or a bout of diarrhea. Most heal with fiber, stool softeners, sitz baths, and prescription ointments that relax the muscle and let blood flow return to the area. Many people have both a fissure and hemorrhoids at the same time, which is why treating the hemorrhoid alone sometimes leaves the pain untouched. See our page on anal fissure treatment in Fort Smith for more detail.

Anal abscess and fistula

An anal abscess is a pocket of infection near the anus. It causes increasing pain, a firm and tender swelling, and often fever or chills. Unlike a hemorrhoid flare, the pain builds steadily rather than easing between bowel movements. An abscess needs to be drained promptly. Antibiotics alone usually are not enough. After drainage, some patients develop a fistula, a small tunnel between the anal canal and the skin that drains pus or fluid and generally needs surgical repair. If you have a painful lump with fever or spreading redness, seek care right away rather than waiting for an appointment.

Pruritus ani (chronic anal itching)

Persistent itching around the anus is often blamed on hemorrhoids when the real cause is skin irritation. Moisture, vigorous wiping, scented soaps and wipes, long-term use of steroid creams, skin conditions such as eczema or psoriasis, and even certain foods and drinks can all keep the cycle going. Hemorrhoids and fissures can contribute by letting small amounts of moisture or stool seep onto the skin. Treatment usually means finding the trigger, keeping the area clean and dry with gentle care rather than scrubbing, and breaking the itch-scratch cycle. Itching that will not settle deserves an exam, because it can occasionally signal a skin condition that needs a different treatment entirely.

Inflammatory bowel disease (Crohn's disease and ulcerative colitis)

Inflammatory bowel disease is chronic inflammation of the digestive tract, and rectal bleeding is one of its common signs. What separates it from hemorrhoids is the company the bleeding keeps: ongoing diarrhea, urgency, mucus in the stool, cramping abdominal pain, symptoms that wake you at night, unexplained weight loss, fatigue, or joint, eye, and skin problems. Ulcerative colitis affects the lining of the rectum and colon. Crohn's disease can affect any part of the digestive tract and sometimes causes anal fissures, abscesses, and fistulas that keep coming back, a pattern that should always prompt a closer look. IBD is diagnosed with colonoscopy and tissue samples, and it is managed long-term with medication rather than a single procedure.

Diverticular bleeding

Diverticula are small pouches that form in the wall of the colon and become more common with age. Most cause no trouble at all, but a blood vessel next to one can occasionally rupture. Diverticular bleeding is usually painless and sudden, and often involves a larger amount of blood, bright red or maroon, than a hemorrhoid would produce. It frequently stops on its own, but it should never be shrugged off. Any episode of heavy rectal bleeding, or bleeding that leaves you lightheaded, warrants urgent evaluation.

Colon polyps and colorectal cancer

This is the reason we take rectal bleeding seriously. Colon polyps are growths in the lining of the colon; some types can slowly turn into cancer over years. Both polyps and early colorectal cancer often cause no symptoms at all, and when they do, the symptoms overlap almost perfectly with hemorrhoids: blood in the stool, a change in bowel habits, narrower stools, cramping, and fatigue from anemia. Colon cancer screening in Fort Smith begins for average-risk adults at age 45. If a parent, sibling, or child has had colorectal cancer or advanced polyps, screening usually starts earlier, and your family history should guide the timing. Rates have been rising in younger adults, which is part of why the recommended starting age moved down. A colonoscopy is the only test that can find polyps and remove them in the same visit, which is what makes it preventive rather than merely diagnostic. If you are due for screening, treating your hemorrhoids is a good moment to take care of both.

Why it matters that your hemorrhoid doctor can also scope you

A clinic that only places bands can only find problems a band can fix. Dr. Ihab Herraka is a board-certified gastroenterologist who performs hemorrhoid banding, colonoscopy, and upper endoscopy, so your evaluation is not limited by the equipment in the room. In practical terms, that means one physician examines you, decides whether your symptoms fit hemorrhoids, and can move directly to a colonoscopy in our on-site endoscopy suite if anything does not add up. There is no second referral, no repeating your story, and no gap where a serious diagnosis can be missed while you are being treated for something else. It also means that if banding is the right treatment, you can have it done in the same practice, and if another approach fits better, you will be told so honestly.

When to be seen right away

Make an appointment promptly, or seek emergency care, if you have any of the following:

• Heavy rectal bleeding, or bleeding that makes you feel lightheaded, weak, or short of breath
• Black, tarry stools
• A painful anal lump with fever, chills, or spreading redness
• Ongoing diarrhea with blood, mucus, urgency, or night-time symptoms
• Unexplained weight loss, persistent abdominal pain, or fatigue with anemia
• A change in bowel habits lasting more than a few weeks
• Any rectal bleeding if you are 45 or older and have never been screened for colon cancer Bleeding that you have already been told is hemorrhoids still deserves another look if it changes, worsens, or does not improve with treatment.

Cost & insurance

An office evaluation for rectal bleeding or anal pain is a medical visit, and it is covered by most plans subject to your deductible, copay, and coinsurance. Colonoscopy is covered as well, though screening and diagnostic colonoscopies are sometimes billed differently, and our staff will explain which applies to you before your procedure. We accept most major plans, including Medicare and both Arkansas and Oklahoma Medicaid. The full list is on our insurance page. Call the clinic and our team will verify your benefits in advance so there are no surprises.

Get a clear answer, not a guess

If you are dealing with rectal bleeding, pain, or itching anywhere in the River Valley, including Fort Smith, Van Buren, Greenwood, Alma, Barling, Charleston, or across the line in Poteau and Sallisaw, the right first step is an exam by a gastroenterologist who can follow the answer wherever it leads. Visit Digestive & Liver Center of Arkansas at our Main Clinic, 3416 Old Greenwood Rd, Fort Smith, AR 72903, open Monday through Friday, 8:00 to 5:00. Call (479) 242-2888 to schedule your evaluation, or learn more about hemorrhoid care with Dr. Herraka.