6.APR.2018 2 MIN READ | 2 MIN READ

Blood in the stools can be alarming, and an indication of something more serious like colorectal cancer, the most common cancer in Singapore.

Last updated on 18 November 2020

Haemorrhoids and colorectal cancer

Haemorrhoids (piles) and colorectal cancer are very different conditions, but they can both produce blood in the stools, according to Dr Mark Wong, general surgeon at Mount Elizabeth Novena Hospital.

Similar symptoms between haemorrhoids and colorectal cancer

Rectal bleeding

Both haemorrhoids and colorectal cancer cause rectal bleeding. They may be noticed when you wipe with a toilet paper or in your stool after a bowel movement. Blood coming from the rectum and colon are usually bright red in colour.

Rectal and anal itching

Rectal and anal itching are present in both haemorrhoids and colorectal cancer. It is caused by mucus and stool that irritate the sensitive skin inside the rectum and around the anus. The itchiness usually intensifies after a bowel movement and may worsen at night.

Lump in the anus

A lump at the anal opening may be noticed when you have external haemorrhoids or colorectal cancer. The lump may be hard and painful.

Differences in symptoms between haemorrhoids and colorectal cancer

Change in bowel habits

A change in bowel habits is a common warning sign of colorectal cancer. This may include changes to the frequency or consistence from your normal bowel movements.

Abdominal discomfort

Colorectal cancer can cause persistent abdominal pain or discomfort, including gas, bloating, and cramps.

Unexplained weight loss

Many people with colorectal cancer experience unexplained weight loss, depending on the location and stage of the cancer.

Feeling of incomplete bowel emptying

People with colorectal cancer sometimes may feel that they want to pass stools even though their bowels are empty.

Weakness or fatigue

Fatigue is a common symptom of cancer. Additionally, bleeding in the intestinal tract can cause anaemia, which also result in fatigue and weakness.

Rectal pain

The presence of rectal pain is more likely to indicate internal haemorrhoids. Colorectal cancer is often painless.

What are haemorrhoids?

Haemorrhoids, or piles, as they are more commonly known, are normal structures in the anus, comprising mainly blood vessels that help to preserve continence and prevent our stools from leaking.

Haemorrhoidal disease

They start to become bothersome when they swell, and this may result in bleeding, pain and itching. This is termed haemorrhoidal disease.

Symptoms of haemorrhoids

Most people will experience such problems at some point in their lives either due to:

  • Straining on the toilet because of constipation
  • Bouts of diarrhoea
  • During pregnancy
  • Result of poor toileting habits such as sitting on the toilet bowl for too long

When should I be concerned about colorectal cancer?

When to be concerned
There are certain ‘red flag’ symptoms which could suggest that bleeding from the bottom may be due to a more serious condition like cancer.

Symptoms of colorectal cancer

  • Signs of ongoing blood loss, where you become pale, tired and breathless with minimal exertion such as simply walking on flat ground
  • A significant loss of weight and appetite
  • Passage of mucus and pain when opening your bowels
  • Passage of narrow or pencil-thin stools
  • Changes in bowel habits like alternating constipation and diarrhoea

You should always seek medical attention early when there is bleeding from below, especially when it is accompanied by the symptoms mentioned above, as the treatment and outcomes of piles and cancer are vastly different.

A colonoscopy is the gold standard of checking the colon and rectum to confirm the cause of bleeding as it is accurate and also allows for a biopsy to confirm if any abnormality seen is due to .

Learn more about colonoscopy and make an appointment with a doctor to find out more.

How are haemorrhoids treated?

Treatment of hemorrhoids comprises of 3 aspects: lifestyle modifications, medications and surgery. Treatment should be individualised and, depending on the severity of symptoms, surgery is not always needed.

Treatment is aimed at reducing the swelling and returning the piles to their normal size and position in the anus and not removing them entirely, because doing so would cause the patient to have stool incontinence.

An important factor for the success of any treatment lies in identifying the underlying cause and triggers for the bleeding and ensuring this is corrected.

Lifestyle changes

Lifestyle modifications include relief from constipation or diarrhoea, ensuring you do not strain excessively or sit for too long on the toilet bowel (usually not more than 10 minutes).

Medication

Medications usually consist of Daflon to reduce swelling as well as either stool softeners when constipated, or fibre supplements to increase stool bulk when stools are loose.

Surgery

Only when the above measures fail or when symptoms are severe at the onset (eg. severe pain, swelling or bleeding) is surgery needed.

The type of surgery should be tailored based on the symptoms of the piles, which can include cutting, sealing or stapling the swollen haemorrhoidal tissue.

How is colorectal cancer treated?

Colorectal cancer treatment
In the majority of cases, the most effective treatment for colorectal cancer is surgery. If detected early, colorectal cancer in the early stages has very promising cure rates.

Minimally invasive surgery

Nowadays, keyhole or minimally invasive surgery (laparoscopic or robotic) is regarded as the standard of care. This allows us to remove the colorectal cancer more effectively through smaller incisions, potentially resulting in smaller wounds, less pain and a quicker recovery for the patient.

Other treatments include chemotherapy and radiotherapy, but this is generally reserved for more advanced cancers that have spread beyond the colon and rectum.

Chemotherapy

Chemotherapy may be administered in several ways to treat colorectal cancer:

  • Neoadjuvant chemotherapy is used before surgery to shrink a tumour so that the surgeon can remove it completely with fewer complications.

  • Adjuvant chemotherapy is given after surgery to remove a tumour to kill any remaining cancer cells.

  • Palliative chemotherapy is given when colorectal has spread to other parts of the body. It is aimed at easing symptoms and extending lifespan.

There are many types of chemotherapy drugs available. Sometimes, 2 or more are given in combination. They may be administered orally, as a tablet or intravenously, and are usually given in cycles of 2 or 4 weeks.

Radiotherapy

Radiotherapy refers to treatment using high energy X-rays, electron beams, or chemical agents called radioactive isotopes to kill cancer cells. Several forms are available:

  • External radiation therapy is the most common form for people with colorectal cancer. Treatment involves radiation beams being targeted at certain spots on the body.

  • Internal radiation therapy uses a tube to place small pellets of radioactive material directly into the tumour.

  • Endocavity radiation therapy is often used for rectal cancer, where a device is placed in the anus to carry radiation directly to the tumour.


To learn more about piles and colorectal cancer, consult a doctor to learn about the treatments available.

If you’re worried about the cost of surgery, Mount Elizabeth Hospitals offer price guarantee for your haemorrhoidectomy so you can budget for the procedure without any bill shock afterwards. This will give you the peace of mind you need to go ahead without any unwanted surprise fees. Learn more about Price Guarantee Procedures.

The improvement on your quality of life can be dramatic, so it’s important to prioritise treatment if you need it.

 

Article contributed by Dr Mark Wong, general surgeon at Mount Elizabeth Novena Hospital

References

Hemorrhoids vs. Colorectal Cancer: Comparing Symptoms (2019, April 26) Retrieved October 27, 2020, from https://www.healthline.com/health/can-hemorrhoids-cause-cancer#differences

Colorectal Cancer. (2020, September 17) Retrieved November 18, 2020, from https://www.webmd.com/colorectal-cancer/guide/colorectal-polyps-cancer#4-10

Chemotherapy for Colorectal Cancer. (2019, November 10) Retrieved November 18, 2020, from https://www.webmd.com/colorectal-cancer/chemotherapy#2

6.APR.2018
img
Wong Te Ching Mark
General Surgeon
Mount Elizabeth Hospital

Dr Mark Wong is a general surgeon practising at Mount Elizabeth Novena Hospital.