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Ulcerative Colitis and Hemorrhoids

Around two-thirds of the world’s population suffers from hemorrhoids. While ulcerative colitis is not as common as hemorrhoids, the two conditions are intimately linked. So let’s explore the difference between ulcerative colitis and hemorrhoids, how they are linked, and what you can do if you develop hemorrhoids on top of ulcerative colitis.

What’s the difference between ulcerative colitis and hemorrhoids?

Ulcerative colitis and hemorrhoids are two different medical conditions. They are caused by different mechanisms, affect different populations, and are treated differently.

However, the two conditions can produce similar symptoms, which can lead you to confuse the two. These include blood on the toilet paper after having a bowel movement, and anal discomfort and itching. Let’s look at how the two conditions differ.

Ulcerative colitis

Ulcerative colitis is an autoimmune disease, which means it occurs when the body attacks itself. The focus of the attack is usually the rectum (the terminal part of your bowel), which is almost always involved. As the body attacks itself, multiple ulcers form throughout the large intestine, which can bleed and give you bloody stools (just like hemorrhoids).

Doctors don’t really know what triggers ulcerative colitis, but here are the symptoms you may experience if you have it:

  • Abdominal pain
  • Bloody diarrhea
  • Fever
  • Fatigue
  • Weight-loss
  • Extraintestinal symptoms like eye inflammation, joint pain, and liver disease

Hemorrhoids

Unlike ulcerative colitis, hemorrhoids don’t involve ulcer formation. Instead, hemorrhoids are swollen masses of rectal veins that may cause perianal itching, rectal bleeding, and sometimes prolapse out of your anal canal.  

The main symptoms of your hemorrhoids will depend on their location. Internal hemorrhoids are located relatively up in the rectum, so their main symptoms are blood-stained stools (or blood on the toilet paper) and prolapse. You should know that until internal hemorrhoids prolapse out of your anal canal, they are usually painless.

External hemorrhoids are located just inside your anal canal, which makes them painful. Because they’re so close to the anal area, they can cause irritation and inflammation in the area, leading to anal itching, pain, and a lump that you may feel while setting.

Another important difference between ulcerative colitis and hemorrhoids is that hemorrhoids have well-documented risk factors. These include:

  • Low-fiber diet
  • Pregnancy
  • Old age
  • Prolonged diarrhea
  • Prolonged constipation, leading to straining
  • Enema and laxative abuse
  • Heavy weight lifting
  • Prolonged sitting on the toilet

The risk factors for ulcerative colitis are not as well-documented as these, and doctors are still trying to find out why the disease occurs.

Are hemorrhoids a sign of ulcerative colitis?

Hemorrhoids are not a classic sign of ulcerative colitis, but they can occur on top of it. In fact, people with ulcerative colitis have a higher risk of developing hemorrhoids than the general population. That’s because ulcerative colitis leads to prolonged diarrhea, which is a risk factor for hemorrhoids.

Ulcerative proctitis is a milder form of ulcerative colitis and only affects the rectum. People with ulcerative proctitis may experience:

  • Bloody diarrhea
  • Constipation
  • A sense of urgency to pass stool
  • A sensation of incomplete emptying after having a bowel movement

All of this can lead to increased irritation in the anal and perianal area, leading to hemorrhoid formation.

How to differentiate between ulcerative colitis and hemorrhoids? 

To differentiate between ulcerative colitis and hemorrhoids, you’ll need to visit a doctor (preferably, a gastroenterologist).

Both conditions can cause blood on the toilet paper, and your doctor will try to determine whether the cause is hemorrhoids or ulcerative colitis. If you have external hemorrhoids, they may be easily visible to the doctor, in which case he won’t need to carry out more invasive investigations

However, if the cause of your bleeding is not clear, your doctor will proceed to invasive investigations.

He may perform a digital rectal examination, which involves assessing your recturm by passing a gloved, lubricated finger via your anal opening. The procedure might cause you slight discomfort, however, most patients report no discomfort.

Your doctor may also perform a sigmoidoscopy, which involves taking a long, flexible tube attached to a camera to look at the lower third of your colon. This is where ulcerative colitis mostly occurs, and if ulcers are visible on sigmoidoscopy, your doctor may take a small biopsy to confirm the diagnosis.

Sometimes, blood tests to look for antibodies (like p-ANCA) may also aid in the diagnosis of ulcerative colitis.

Finally, a careful medical history and exploration of risk factors for hemorrhoids will also help your doctor determine the cause of your rectal bleeding.

How to treat hemorrhoids with ulcerative colitis?

If you develop hemorrhoids on top of your ulcerative colitis, there are few basic principles you can use to manage your condition. The most important of these is to know that most small hemorrhoids will go away on their own. To speed up this process, here are a few things you can try:

  • Add fiber to your diet
  • Take a sitz bath
  • Maintain good anal hygiene — especially after an episode of diarrhea due to ulcerative colitis
  • Use cushioned surfaces for sitting
  • Use an over-the-counter pain medication like acetaminophen
  • Use an over-the-counter ointment for hemorrhoids

However, you should seek medical attention for your hemorrhoids if they:

  • Don’t regress within a week
  • Prolapse
  • Cause severe pain or bleeding

Your doctor can employ a variety of in-office procedures to treat hemorrhoids that don’t go away on their own, including rubber band ligation, sclerotherapy, and infrared photocoagulation. If your hemorrhoids still persist, you may need a surgical procedure like hemorrhoidectomy.

You should note that various reports indicate that patients with ulcerative colitis have an increased risk of complications following a surgical procedure for hemorrhoids. But you should discuss your options and prognosis with your doctor before making a decision.

Finally, getting treatment for ulcerative colitis may reduce your risk of future hemorrhoid development. Ulcerative colitis is treated via a range of drugs (like mesalamine) and surgical procedures (like colectomy), and the best treatment for your case will be determined by a doctor.

Medically Reviewed by Onikepe Adegbola, MD PhD


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