Hemorrhoids and Rectal Cancer Concerns: What You Need to Know

Concerns about hemorrhoids and colorectal cancer?

Hello, doctor: About 20 days ago, I experienced bleeding from internal hemorrhoids (a small amount of blood dripping or bleeding when wiping).
I bought hemorrhoid relief pills and ointment, which helped stop the bleeding.
However, after each bowel movement, the internal hemorrhoids protrude, and I have to gently push them back in with moist wipes.
Sometimes, I see a little pink on the wipes while pushing, which makes me very anxious about bleeding again.
Eventually, I mustered the courage to see a doctor.
The consultation was very quick; the doctor only examined the external hemorrhoids (but my main concern is the internal ones) and said they were swollen, then prescribed a hemorrhoid ointment and anti-inflammatory medication.
Using the ointment and anti-inflammatory medication has improved the situation; there is less pain, but the internal hemorrhoids still protrude after bowel movements, and they don't seem to have shrunk much.
However, pushing them back in now does not cause bleeding.
I have a few questions for the doctor: 1.
If I continue taking the anti-inflammatory medication and using the ointment, is it possible for the internal hemorrhoids to shrink and reduce the protrusion? If I stop the medication, will the condition return to what it was before? 2.
In the case of internal and external hemorrhoids, can the rubber band ligation method be used to improve the internal hemorrhoids? 3.
When applying the medication, I felt a hard, semi-circular lump about the length of my entire index finger inside the rectum, with a smooth surface.
I am 36 years old, my weight has not decreased, and the previous bleeding was bright red.
Could this possibly be a rectal cancer lump?

N, 30~39 year old female. Ask Date: 2015/12/16

Dr. Ke Fangxu reply Surgery

1.
Continuing the medication should help improve the condition of hemorrhoidal prolapse; however, achieving complete resolution of the hemorrhoids may be difficult.
It is recommended to shorten the duration of bowel movements to avoid exacerbating the prolapse.
2.
Internal hemorrhoids can be treated with rubber band ligation, but this method is not recommended for external hemorrhoids due to the potential for pain at the wound site and an increased risk of infection.
3.
If your entire index finger is inserted, the smooth mass you feel is likely the uterus.
It is advised not to apply medication too deeply in that area.
Although the risk of developing colorectal cancer at the age of 36 is not zero, it is generally considered low.
If you are still very concerned, you may arrange for a colonoscopy.

Reply Date: 2015/12/16

More Info

Understanding hemorrhoids and rectal cancer concerns is crucial for maintaining gastrointestinal health, especially when symptoms such as bleeding and protrusion occur. Here’s a comprehensive overview addressing your concerns and providing insights into hemorrhoids, their treatment, and the potential implications for rectal cancer.

1. Understanding Hemorrhoids
Hemorrhoids are swollen veins in the lower rectum and anus, similar to varicose veins. They can be classified into two types: internal and external. Internal hemorrhoids are located inside the rectum and are usually not visible, while external hemorrhoids are located under the skin around the anus and can be seen and felt.

Symptoms of hemorrhoids include:
- Bleeding during bowel movements (often bright red blood)
- Pain or discomfort, especially with external hemorrhoids
- Protrusion of tissue during bowel movements
- Itching or irritation in the anal region

2. Treatment Options
You mentioned using topical medications and anti-inflammatory drugs, which can help alleviate symptoms but may not address the underlying issue of hemorrhoids. Here are some treatment options:
- Conservative Management: This includes dietary changes (increasing fiber intake), hydration, and over-the-counter medications. These can help reduce symptoms and prevent further complications.

- Rubber Band Ligation: This is a common procedure for internal hemorrhoids where a rubber band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off. This method is effective for internal hemorrhoids but may not be suitable if external hemorrhoids are present.

- Surgical Options: If conservative treatments fail, surgical options such as hemorrhoidectomy may be considered. This involves the surgical removal of hemorrhoids.

3. Concerns About Rectal Cancer
Your concern about the possibility of rectal cancer is valid, especially given the presence of a hard lump in the rectal area. While hemorrhoids can cause similar symptoms, it is essential to differentiate between the two.

- Symptoms of Rectal Cancer: These can include changes in bowel habits, unexplained weight loss, persistent abdominal discomfort, and blood in the stool. The presence of a hard, smooth lump could be concerning, but it is not definitive for cancer.

- Screening and Diagnosis: Given your age (36 years) and symptoms, it is advisable to undergo a thorough evaluation, including a digital rectal exam and possibly a colonoscopy. These procedures can help visualize the rectum and colon, allowing for the identification of any abnormal growths or lesions.

4. Addressing Your Specific Questions
1. Will continued use of medications reduce the size of internal hemorrhoids?: While medications can help manage symptoms, they may not significantly reduce the size of hemorrhoids. Stopping the medication might lead to a return of symptoms. It’s essential to follow up with your healthcare provider for a tailored treatment plan.

2. Can rubber band ligation be used for both internal and external hemorrhoids?: Rubber band ligation is primarily effective for internal hemorrhoids. If external hemorrhoids are present, other treatments may be necessary.

3. Could the lump be a sign of rectal cancer?: While the lump you described could be a hemorrhoid, it is crucial to have it evaluated by a healthcare professional. A thorough examination and possibly imaging studies will help determine its nature.

Conclusion
In summary, while hemorrhoids can cause significant discomfort and concern, it is essential to differentiate them from more serious conditions like rectal cancer. Regular follow-ups with your healthcare provider, adherence to treatment plans, and appropriate screening are vital for managing your symptoms and ensuring your health. If you have persistent symptoms or new concerns, do not hesitate to seek further medical evaluation.

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