Hemorrhoids: Symptoms, Causes, and Concerns

Hemorrhoids? Or something undesirable?

Hello Doctor, I have some questions I would like to ask:
1.
Recently, I suddenly recalled an instance when I noticed my stool appeared red from a distance, but upon closer inspection, it was brown.
However, I cannot deny that there was likely blood in the stool.
I have previously consulted a physician about hemorrhoids and would like to know if this situation could occur with internal hemorrhoids.
I often see distinctions made between colorectal cancer and hemorrhoids, stating that colorectal cancer presents with mixed blood in the stool, while hemorrhoids have separated blood.
However, I have also heard that internal hemorrhoids can lead to mixed blood in the stool.
Could this situation occur with internal hemorrhoids? Since that incident (around mid-January), I have not experienced any similar symptoms or blood in my stool.
2.
I would like to ask if hemorrhoids or colorectal cancer can cause difficulty in passing gas.
Some people say that hemorrhoids or colorectal cancer can increase the frequency of passing gas, while others say it can decrease it.
Recently, I often feel difficulty in passing gas; it’s not that I don’t feel the need to pass gas, but I have to exert some effort to do so.
However, at certain times in the evening (always in the evening), I find myself passing gas frequently and can feel some movement in my abdomen (gurgling sounds or some agitation, but not to the extent of needing to rush to the bathroom).
The frequency can exceed 20 times in one evening.
What could be causing this? Is it possible that, aside from not knowing whether I have hemorrhoids or a tumor, I have other symptoms? Additionally, when I have difficulty passing gas, I often feel discomfort in my sitting position (around the upper part of the groin) and feel as if something is blocking my anus.
However, when I can pass gas more easily, this discomfort does not occur.
Could it be that something is moving around in that area? If it can move, could it still be something as simple as hemorrhoids?
3.
There was a time when after bowel movements, I would always wipe and find small, granular pieces of stool.
They were very small, taking up less than a fraction of the toilet paper (which was folded twice), but I had to wipe many times to feel clean.
What could cause this situation?
4.
My bowel movements have become very difficult; often, the front part of the stool comes out, but the back part does not come out easily, requiring some effort to push it out.
The stool that comes out is almost a yellowish-brown color.
5.
Recently, I have often felt itching around the anus.
This situation has improved over the past few days, but I notice that the feeling is most pronounced and frequent after a bowel movement (though the frequency has decreased in recent days).
What could this situation be?
I kindly ask the doctor to clarify these issues.

Yun An, 10~19 year old female. Ask Date: 2020/03/06

Dr. Ke Fangxu reply Surgery

1.
At the age of 4.17 years, the likelihood of developing colorectal cancer can be considered negligible.
Judging the cause of bleeding based on its appearance to determine whether it is hemorrhoidal or colorectal cancer bleeding is inaccurate.
Your condition is likely due to hemorrhoidal bleeding.
It is recommended to start with a light diet and maintain a good lifestyle.
Spicy, irritating, and greasy foods should be avoided, and increasing dietary fiber intake can be beneficial.
If symptoms persist without improvement, you may consult a physician for medication or a colonoscopy.
2.
Difficulty in passing gas occurs only in patients with advanced colorectal cancer causing obstruction; this is not the case for hemorrhoids.
If there is excessive intestinal gas, it is advisable to reduce the intake of starchy foods and supplement with probiotics, which may help improve the situation.
3.
Due to the folds of skin around the anus, there may be instances of inadequate cleaning.
It is recommended to use a bidet to avoid skin damage from excessive wiping.
5.
Anal itching may be caused by excessive wiping.
In addition to medication and topical treatments, three important points should be noted:
1.
Do not scratch to prevent wound infection.
2.
Temporarily avoid spicy foods to prevent capsaicin from irritating the skin.
3.
Avoid using soap or body wash to clean the anal area to prevent excessive removal of the skin's natural oils.
If these measures are followed, improvement can generally be seen within about a week.
If there is no improvement, it is advisable to consult a physician for evaluation and medication.

Reply Date: 2020/03/06

More Info

Understanding hemorrhoids and their symptoms is essential for anyone experiencing discomfort or changes in bowel habits. Hemorrhoids, also known as piles, are swollen veins in the lower rectum and anus that can cause a variety of symptoms, including bleeding, pain, and itching. Here’s a comprehensive overview addressing your concerns.

1. Blood in Stool and Internal Hemorrhoids: It is indeed possible for internal hemorrhoids to cause blood in the stool. Typically, hemorrhoid-related bleeding is bright red and may appear on the toilet paper or the surface of the stool. The distinction between hemorrhoid bleeding and blood associated with colorectal cancer can be nuanced. While hemorrhoids often cause blood that is separate from the stool, internal hemorrhoids can sometimes lead to mixed blood in the stool, especially if there is significant straining during bowel movements. However, the absence of recurrent bleeding after your initial episode is a positive sign. It’s crucial to monitor any future occurrences and consult a healthcare provider if bleeding resumes.

2. Flatulence and Hemorrhoids or Cancer: Hemorrhoids can indeed affect your ability to pass gas comfortably. They may cause discomfort or a sensation of pressure, leading to difficulty in releasing gas. Increased flatulence can occur due to dietary factors or gastrointestinal disturbances rather than directly from hemorrhoids or cancer. If you experience a sudden change in your flatulence patterns, especially if accompanied by pain or other gastrointestinal symptoms, it’s advisable to seek medical evaluation. The sensation of needing to exert effort to pass gas could be related to rectal pressure from hemorrhoids or other underlying conditions.

3. Small, Hard Stool Particles: The presence of small, hard stool particles can indicate constipation or incomplete evacuation. This can occur due to a low-fiber diet, dehydration, or irregular bowel habits. When stool is hard, it can break into small pieces, leading to the need for multiple wipes. Increasing fiber intake, drinking plenty of water, and possibly using a stool softener can help alleviate this issue.

4. Difficulty Passing Stool: The difficulty you describe in passing stool, especially if the front part comes out while the rest does not, can be a sign of constipation or rectal obstruction. This could be related to hemorrhoids, anal fissures, or other rectal conditions. The color of your stool, being yellowish or brownish, can be normal, but if you notice significant changes in color or consistency, it’s worth discussing with a healthcare provider.

5. Itching Around the Anus: Anal itching can result from several factors, including hemorrhoids, skin irritation, hygiene issues, or infections. It’s common for itching to worsen after bowel movements due to irritation from stool or wiping. Maintaining proper hygiene, using gentle wipes, and avoiding irritants can help. If the itching persists or worsens, it may be necessary to consult a healthcare provider for further evaluation.

In summary, while your symptoms may suggest hemorrhoids, they could also indicate other gastrointestinal issues. It’s essential to monitor your symptoms closely. If you experience recurrent bleeding, significant changes in bowel habits, or persistent discomfort, it’s crucial to seek medical advice. A healthcare provider can perform a thorough examination, potentially including a digital rectal exam or colonoscopy, to rule out more serious conditions and provide appropriate treatment options. Maintaining a healthy diet rich in fiber, staying hydrated, and practicing good bowel habits can significantly improve your symptoms and overall digestive health.

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