Haemorrhoids (piles) and colorectal cancer are very different conditions, but they can both produce blood in the stools, according to Dr Mark Wong, general surgeon at Mount Elizabeth Novena Hospital.
What is piles?
Haemorrhoids, or piles, as they are more commonly known, are actually normal parts of our body. They are normal structures in the anus, comprising mainly blood vessels that help to preserve continence and prevent our stools from leaking out. They start to become bothersome when they swell and this may result in bleeding, pain and itching. This is termed haemorrhoidal disease. Most people will experience such problems at some point in their lives either due to straining on the toilet because of constipation, bouts of diarrhoea, during pregnancy, or as a result of poor toileting habits such as sitting on the toilet bowl for too long.
When should I be concerned about colorectal cancer?
- Signs of ongoing blood loss, where you become pale, tired and breathless with minimal exertion such as simply walking on flat ground
- A significant loss of weight and appetite
- Passage of mucus and pain when opening your bowels
- Passage of narrow or pencil-thin stools
- Changes in bowel habits like alternating constipation and diarrhoea
You should always seek medical attention early when there is bleeding from below, especially when it is accompanied by the symptoms mentioned above, as the treatment and outcomes of piles and cancer are vastly different.
A colonoscopy is the gold standard of checking the colon and rectum to confirm the cause of bleeding as it is accurate and also allows for a biopsy to confirm if any abnormality seen is due to colorectal cancer.
How are piles treated?
Treatment of piles comprises 3 aspects: lifestyle modifications, medications and surgery. Treatment should be individualised and, depending on the severity of symptoms, surgery is not always needed. Treatment is aimed at reducing the swelling and returning the piles to their normal size and position in the anus and not removing them entirely, because doing so would cause the patient to have stool incontinence.
An important factor for the success of any treatment lies in identifying the underlying cause and triggers for the bleeding and ensuring this is corrected.
Lifestyle modifications include relief from constipation or diarrhoea, ensuring you do not strain excessively or sit for too long on the toilet bowel (usually not more than 10 minutes).
Medications usually consist of Daflon to reduce swelling as well as either stool softeners when constipated, or fibre supplements to increase stool bulk when stools are loose.
Only when the above measures fail or when symptoms are severe at the onset (eg. severe pain, swelling or bleeding) is surgery needed. Once again, the type of surgery should be tailored based on the symptoms of the piles, which can include cutting, sealing or stapling the swollen haemorrhoidal tissue.
How is colorectal cancer treated?
Nowadays, keyhole or minimally invasive surgery (laparoscopic or robotic) is regarded as the standard of care. This allows us to remove the colorectal cancer more effectively through smaller incisions, potentially resulting in smaller wounds, less pain and a quicker recovery for the patient.
Other treatments include chemotherapy and radiotherapy, but this is generally reserved for more advanced cancers that have spread beyond the colon and rectum.
Article contributed by Dr Mark Wong, general surgeon at Mount Elizabeth Novena Hospital