Hemorrhoids and Anal Issues: When to Seek Medical Advice

Intestinal and anal issues?

Hello, doctor.
I would like to ask: (1) If I discover several hemorrhoids both inside and outside my anus, but there is no significant pain, prolapse, or bleeding, do I need to seek medical attention? If left untreated, could it worsen? (2) Occasionally, I experience anal fissures, which cause pain during bowel movements and a bit of bright red blood when wiping, but usually, it resolves within two days.
Should I be concerned about the possibility of cancer? (3) I often see news about young individuals with colorectal cancer, which makes me quite anxious.
My lifestyle habits are not very good; should I undergo specific related screenings? Thank you.

Nìmíng nán, 20~29 year old female. Ask Date: 2022/12/22

Dr. Zhang Shuhao reply Surgery

(1) Hemorrhoids that do not present with significant pain, prolapse, or bleeding may not require treatment and are unlikely to undergo malignant transformation.
Surgery is only necessary when they affect the quality of life.
However, it is recommended to cultivate good dietary and bowel habits to prevent the worsening of hemorrhoids.
(2) The bleeding associated with anal fissures is less likely to be related to cancer.
(3) Young individuals without a family or genetic history of colorectal cancer have a low risk of developing the disease.
If symptoms such as rectal bleeding, abdominal pain, or changes in bowel habits occur, a medical evaluation should be sought, and a colonoscopy should only be performed if there is suspicion of a problem.

Reply Date: 2022/12/22

More Info

When it comes to understanding hemorrhoids and anal issues, it's important to recognize the signs and symptoms that warrant medical attention. Let's address your questions one by one.

1. Presence of Hemorrhoids Without Pain or Bleeding: If you notice multiple hemorrhoids around the anal area but are not experiencing significant pain, prolapse, or bleeding, it may not be immediately necessary to seek medical advice. However, it is essential to monitor the situation. Hemorrhoids can be asymptomatic, but they can also lead to complications if left untreated. While they may not "malign" in the cancerous sense, they can become thrombosed (clotted) or lead to discomfort and other issues. If you notice any changes, such as increased size, pain, or bleeding, it would be wise to consult a healthcare provider.

2. Occasional Anal Fissures: Experiencing anal fissures, especially if they are associated with pain during bowel movements and minor bleeding, is relatively common. These fissures often heal on their own within a few days, especially with proper care, such as maintaining soft stools and good hygiene. However, recurrent fissures can indicate underlying issues, such as chronic constipation or anal sphincter dysfunction. While the presence of fissures does not directly indicate cancer, any persistent symptoms, especially if they change in nature or frequency, should prompt a visit to a healthcare professional for further evaluation.

3. Concerns About Colorectal Cancer: The rising incidence of colorectal cancer, particularly among younger individuals, has understandably raised concerns. If you have risk factors such as a family history of colorectal cancer, personal history of inflammatory bowel disease, or lifestyle factors like a poor diet, lack of exercise, or smoking, it may be prudent to discuss screening options with your doctor. Generally, routine screening for colorectal cancer begins at age 45 for average-risk individuals, but those with risk factors may need to start earlier. Your healthcare provider can recommend the appropriate screening tests, such as a colonoscopy, based on your individual risk profile.

In summary, while the presence of hemorrhoids and occasional anal fissures can often be managed conservatively, it is crucial to remain vigilant about any changes in symptoms. Regular check-ups and open communication with your healthcare provider can help alleviate concerns and ensure that any potential issues are addressed promptly. If you have any doubts or if your symptoms persist or worsen, do not hesitate to seek medical advice. Early intervention can make a significant difference in outcomes, especially concerning conditions like colorectal cancer.

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