Hemorrhoid or cancer? How to tell the difference

Bleeding from the rectum, a lump at the anal opening, or a change in bowel habits - and suddenly the worrying thought appears: could this be cancer? It is a natural question, and you are far from alone in asking it. On this page, specialist Dr. Bahir Hadi explains the typical differences between hemorrhoids and bowel cancer, and when you should get checked.

Short answer: In most cases, the cause is hemorrhoids. But because symptoms can overlap, rectal bleeding should never be ignored - especially if you are over 50, have changed bowel habits for more than 3-4 weeks, or have unexplained weight loss.

Key differences

Symptom	Suggests hemorrhoids	Suggests bowel cancer
Blood colour	Bright red, on the paper or dripping into the bowl	Darker, mixed with the stool
Pain	Burning/itching at the anus, worst on defecation	Often painless - or diffuse abdominal pain
Lump	Soft, tender bump at the anal opening, often transient	Not visible externally; may be felt on rectal exam
Bowel habit	Unchanged or constipated	Persistent change: thinner stools, more/less frequent, urgency
Weight loss and fatigue	Rare	Common in advanced disease
Age	All ages, mostly 30-60	Risk rises sharply after 50

Remember: you can have both at the same time. Hemorrhoids do not rule out cancer. That is why it is always the doctor's job - not the patient's - to determine the cause.

What are hemorrhoids?

Hemorrhoids are swollen blood vessels in or around the rectum, similar to small varicose veins. They are very common: up to half of adults develop them at some point. Typical symptoms:

• Bright red blood on toilet paper or in the bowl after defecation.
• Itching, burning or swelling at the anus.
• A soft lump that may come and go - especially with constipation, pregnancy or sedentary work.

Most hemorrhoids settle with diet, fluids and exercise. When they do not, we offer gentle treatments - from McGivney rubber-band ligation to surgical removal.

What is bowel cancer - and which symptoms matter?

Bowel (colorectal) cancer is the 3rd most common cancer in Denmark. It usually develops slowly from benign bowel polyps that may become malignant over years. Symptoms not to overlook:

• Blood in the stool - especially dark blood or blood mixed with stool.
• Persistent change in bowel habit (>3-4 weeks): thinner stools, diarrhoea, constipation or alternating pattern.
• Sense of incomplete emptying after defecation.
• Unexplained weight loss, fatigue or anaemia.
• Abdominal pain or bloating that does not go away.

Important: Early bowel cancer can be entirely painless. That is precisely why "harmless blood on the paper" should be taken seriously and worked up with a colonoscopy when the doctor considers it indicated.

When should you see a doctor?

Contact your GP without delay if you have one or more of the following:

• You are over 50 and have blood in the stool.
• You have a change in bowel habit lasting more than 3-4 weeks.
• You have unexplained weight loss or fatigue with gastrointestinal symptoms.
• You have a family history (parent or sibling with bowel cancer).
• Symptoms have returned after earlier treatment for hemorrhoids.

You can also contact the clinic directly. With a GP referral, assessment and treatment are free under the Danish national health insurance.

How is the diagnosis made?

At the surgeon's office, the work-up typically includes:

1. Clinical examination - inspection and digital rectal exam. Many hemorrhoids can be seen and felt immediately.
2. Anoscopy/proctoscopy - a short scope of the lower 5-10 cm.
3. Colonoscopy - full scope of the colon if there is suspicion of cancer, polyps or inflammatory bowel disease. Any polyps can be removed during the procedure.

Waiting time for colonoscopy with justified suspicion of cancer is at most 7-10 working days in the Danish cancer fast-track pathway.

Read more

• Rectal bleeding - complete guide
• Hemorrhoids - symptoms and treatment
• Bowel cancer - symptoms and work-up
• Bowel polyps - precursors to cancer
• Colonoscopy - what to expect