Anal cancer vs. hemorrhoids: How to know the difference

What are hemorrhoids?

Hemorrhoids are a part of our normal anatomy. We’re born with them. They’re a collection of veins underneath the skin just inside the anal canal. But if your hemorrhoids become enlarged, you may develop symptoms that cause problems.

What are the symptoms of hemorrhoids?

Hemorrhoid symptoms depend on whether they are

• internal: inside the anus, or
• external: on the skin outside of the anus.

Internal hemorrhoids

An internal hemorrhoid is usually a painless lump that may go away and come back. Internal hemorrhoids often bleed, and they can make you feel like you have the urge to poop. You don’t actually need to poop, but the lump is telling your brain that there’s something in the anus that needs to come out.

Internal hemorrhoids are classified in four stages.

Stage I: This is an enlarged hemorrhoid that is still in the anus and may bleed.

Stage II: If you’re straining to have a bowel movement, you may notice a lump when you wipe. This means the internal hemorrhoid has prolapsed, or bulged out. Stage 2 hemorrhoids do not hurt, but you may experience some pain or discomfort from straining to poop. These hemorrhoids will go back inside the anal canal on their own.

Stage III: The hemorrhoid is large enough to bulge out but does not go back in on its own. You can manually push the hemorrhoid back into the anus.

Stage IV: These hemorrhoids stay out and cannot be pushed back in. They can look pretty unpleasant.

External hemorrhoids

External hemorrhoids are simply defined as ‘present’ or ‘not present.’

‘Not present’ means you’ve never had a symptomatic hemorrhoid. ‘Present’ means you have a hemorrhoid that may be very painful.

As the skin fills with blood, it stretches. That’s why external hemorrhoids are so painful – because they stretch your skin, which happens all at once. It can take several weeks to months for these to resolve. Once the hemorrhoid is gone, the skin stays stretched, and it may remain as a skin tag.

What does a hemorrhoid lump feel like?

An internal hemorrhoid that has prolapsed out of the anus can feel soft and smooth to the touch, almost rubbery.

External hemorrhoids may feel like you have a small grape or marble on the outside of the anus. They may be very painful.

How do I know if I have hemorrhoids or anal cancer?

Anal cancer often does not have any symptoms. When symptoms do appear, sometimes it’s when the cancer is more advanced. Anal cancer symptoms may include:

• anal or rectal bleeding
• pain or pressure around the anus
• change in bowel habits
• a lump close to the anus
• swollen lymph nodes in the anal or groin area
• anal discharge

These symptoms do not always mean you have cancer. Some of these symptoms are also signs of hemorrhoids. So, how can you tell the difference?

For one, pay attention to your body. Let’s say you do a 25-mile run, don’t drink much water and don’t poop for four days. When you finally poop, it’s hard and you have to strain. Your bottom hurts and you notice some blood when you wipe. That’s a classical description of an internal hemorrhoid.

Anal cancer lumps

Another thing to pay attention to is when you wipe or clean yourself. If you discover a lump that feels hard, irregular, rough, coarse or tender to the touch with bleeding, it could indicate something more serious like anal cancer. You should see a doctor to get checked out.

What causes hemorrhoids?

A symptomatic hemorrhoid usually results from an underlying bowel transit disorder, such as constant diarrhea or constipation.

If you have diarrhea multiple times a day, that constant force of pressure increases the blood supply in the anal canal, which can cause hemorrhoids to become symptomatic.  

If you’re straining on the toilet all day because you’re constipated, the same thing will happen.

What are the risk factors for anal cancer?

Risk factors increase your chance of getting anal cancer. If you have any of these risk factors, it does not mean you will get anal cancer. But it’s a good idea to discuss them with your doctor.

Anal cancer risk factors include:

• Age: Squamous cell carcinoma of the anus most often is found in people older than 50. Anal cancer is rare in young adults.
• Prior HPV-related precancerous lesion or cancer of the cervix, vagina, vulva, penis or oropharynx
• Human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)
• Having more than 10 sexual partners
• Anal receptive intercourse, though not in all cases
• Frequent anal redness, swelling and soreness
• Immunosuppression, including taking immune-suppressing drugs after an organ transplant

When to see a doctor for symptoms

It’s not normal for it to hurt when you poop. It’s not normal to itch in your anal area. It’s not normal to have anal bleeding.

Any time something abnormal is happening, don’t assume you have benign hemorrhoids. Go get checked out to get a correct diagnosis and confirm it’s not an anal cancer.

That said, the very first time you see blood probably does not mean you have anal cancer. It should certainly trigger for you that something abnormal is going on. If the symptoms last more than two weeks, get worse, or go away and then come back in a short period of time, you should see a doctor.

How are hemorrhoids diagnosed?

We diagnose hemorrhoids the same way we look for anal cancer.

First, your doctor will perform a digital rectal exam. This is when your doctor inserts a gloved, lubricated finger into your anus to feel for abnormalities, such as hemorrhoids.

Next, your doctor will perform an anoscopy. This is a simple procedure in which your doctor inserts a lubricated tube called an anoscope (typically the same size as a finger) into your anus. Your doctor may wear a headlamp light that allows them to see inside the anal canal and diagnose hemorrhoids.

How are hemorrhoids treated?

Treatment for hemorrhoids can vary, depending on the severity of your symptoms and what will provide you with the best long-term relief.

At MD Anderson, I tell my patients that in order to treat hemorrhoids, we must first address the GI transit problem. This may include:

• Taking fiber supplements with a small amount of water or other bulking agents to help bulk up stool and alleviate diarrhea
• Using stool softeners or drinking more water to help with constipation

Your doctor may suggest you apply cream or ointment to the skin to help relieve symptoms.

Surgery is not recommended for stage I and II hemorrhoids. However, surgery may be considered for internal hemorrhoids that are stage III or stage IV, but I don’t recommend it.

Here’s why.

If you have hemorrhoid surgery without fixing the root cause of the hemorrhoids (constant diarrhea or constipation), the hemorrhoids will come back. Plus, you risk possible scarring from the surgery that may lead to pooping problems later on.

Still, every situation is different. It’s best to discuss your specific treatment options with your doctor.    

How is anal cancer treated?

Treatment for anal cancer depends on several factors, including:

• The cancer’s stage
• Location of the tumor
• If the cancer is a new diagnosis or a recurrence
• Your overall health

Your treatment may include surgery or combined chemotherapy with radiation. You may also be eligible for clinical trials. Your doctors will develop the best treatment plan for your particular needs.

There’s nothing shameful about prioritizing your health

Anything related to the anus is typically considered to be an embarrassing topic. But there’s nothing to be embarrassed about.

The anus is just another body part, like your arm, leg or foot.

Sometimes, people will delay seeing a doctor for anal issues because of embarrassment. But this can delay diagnosis and treatment. Anal cancer can be easier to treat when it’s found early.

Most anal symptoms are not due to anal cancer. They could be caused by benign conditions like hemorrhoids, anal fissures or anal fistulas.

See your doctor if you’re having abnormal symptoms, so they can figure out what’s going on and get you treated. Remember: you’re your best advocate when it comes to your health.

Craig Messick, M.D., is a colon and rectal surgeon at MD Anderson.

Request an appointment at MD Anderson online or call 1-877-632-6789.