Hemorrhoids and colorectal polyps. Early detection increases chances of being successfully cured.

Hemorrhoids are the most common cause of rectal bleeding, but colorectal cancer can also cause rectal bleeding. Due to the similarity of manifestations, patients are often confused, leading to delayed diagnosis and ineffective treatments. Therefore being aware of the specific warning signs and symptoms results in early detection and appropriate treatments.

Get to know “hemorrhoids”

Hemorrhoids are swollen veins in the anus and lower rectum. The veins around the anus tend to stretch under pressure, causing bulge or swelling. This condition can develop from increased pressure in the lower rectum. Hemorrhoids might develop in different locations at the same time. Classified by locations, there are 2 types of hemorrhoids:

1.) Internal hemorrhoids

Internal hemorrhoids lie inside the rectum which located above the pectinate line and are covered with cells that are the same as those that line the rest of the intestines. Internal hemorrhoids cannot be typically seen or felt. Only using anoscopy, proctoscopy and sigmoidoscopy allows gastroenterologists to examine the inner lining of the rectum. Internal hemorrhoids can be stratified into 4 grades:

• Grade I: The internal hemorrhoid bulges into the canal but does not prolapse. These may cause rectal bleeding.
• Grade II: The hemorrhoid protrudes through the rectum with straining during a bowel movement. But it spontaneously returns to their original position once the straining has subsided after bowel movements. 
• Grade III: The hemorrhoid protrudes without any straining and requires the patient to push it inside manually.
• Grade IV: The hemorrhoid protrudes and cannot be pushed back, causing discomfort and rectal pain. 

2.) External hemorrhoids 

External hemorrhoids are hemorrhoids that affect veins outside the anus. External hemorrhoids arise below the pectinate line and are covered with cells that resemble skin which are typically slightly less pink than the surrounding skin. External bulges can be seen and touched around the anal area. Symptoms might include itching or irritation in the anal region, pain or discomfort, swelling around the anus and rectal bleeding.

Risk factors of hemorrhoids

Hemorrhoids can develop from increased pressure in the lower rectum due to:

• Straining during bowel movements
• Frequent bowel movements
• Sitting for long periods of time on the toilet
• Having chronic diarrhea or constipation
• Using laxative or rectal enema unnecessarily
• Advanced age that makes tissues supporting the veins in rectum and anus become weak and stretch
• Chronic cough 
• Being obese
• Regular heavy lifting
• Cirrhosis that results in bulging veins in the anus area
• Genetics with family history of hemorrhoids 
• Being pregnant when baby puts pressure on the anal region

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Signs and symptoms of hemorrhoids VS. colorectal cancer

Hemorrhoids have certainly shared similar manifestations with colorectal cancer. If these warning signs and symptoms are exhibited, immediate medication attention must be sought in order to receive appropriate and timely treatments. These symptoms include:

Diagnosis of hemorrhoids.

For external hemorrhoid, it is usually seen by the specialists. Diagnosing internal hemorrhoids might include examination of the anal canal and rectum. Tests and procedures are digital examination by inserting a gloved, lubricated finger into the rectum and identifying abnormal signs, visual inspection to examine the lower portion of the colon and rectum with an anoscope, proctoscope or sigmoidoscope and other tests such as computerized tomography scan (CT) and endoanal – endorectal ultrasonography. If colorectal cancer is potentially suspected, colonoscopy, the endoscopic examination of the large bowel and rectum might be considered to verify a confirmatory diagnosis, leading to appropriate treatment plans.

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Treatment of hemorrhoids

Selected treatment options entirely depend on presenting symptoms and disease severity as well as individual conditions of the patients. Treatment options include:

1) Non-surgical approach consists of 

• Rectal suppositories or ointments
• Injection (sclerotherapy). A chemical solution is injected into the hemorrhoid tissue in order to shrink it by damaging blood vessels and reducing the blood supply to the hemorrhoids. The interval for injection is very 2-4 weeks. 
• Rubber band ligation. During procedure, one or two tiny rubber bands are placed around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week.
  Hemorrhoid banding can be uncomfortable and cause bleeding, therefore it should be performed by highly experienced specialists in order to reduce risks of serious complications. 

2) Surgical approach

If other procedures have not been successful or patients have large hemorrhoids that cannot be pushed in place, surgery is highly recommended. Types of surgery is determined by sizes and types of hemorrhoids as well as locations. Surgical options are:

• Open hemorrhoidectomy: An open hemorrhoidectomy is surgery to remove internal or external hemorrhoids that are extensive, large or severe.
• Stapled hemorrhoidectomy: Stapled hemorrhoidectomy is mostly used in patients with extensive hemorrhoids. During stapled hemorrhoidectomy, a circular stapling device is used to excise a circumferential ring of excess hemorrhoid tissue, thereby lifting hemorrhoids back to their normal position within the anal canal. Stapling also disrupts hemorrhoid blood supply. Studies have suggested that stapled hemorrhoidectomy results in less post-operative pain and shorter recovery compared with conventional surgery.
• Laser hemorrhoidectomy: Hemorrhoid laser procedure is a new laser procedure for treatment of hemorrhoids in which hemorrhoidal blood flow feeding the hemorrhoidal plexus is stopped by laser coagulation. It is recommended in hemorrhoids with mild stage while the size is still small. This procedure causes less pain, faster recovery time and fewer post-operative complications or side effects.

In case that colorectal cancer has been diagnosed instead of hemorrhoids, it can be treated by “minimally invasive colorectal surgery with sphincter saving technique”. It substantially helps to preserve sphincter muscles functions and regulate bowel movements as well as reduce chances of having permanent colostomy. If there is the presence of warning signs and symptoms, immediate medical care must be provided in order to get it accurately diagnosed, resulting in timely and effective treatments that eventually enhance quality of life.