Blood in the stool: is it piles or something more?

Many people in India notice blood in their stool and assume it is piles. Often they are right: piles are very common and usually harmless. But colorectal (bowel) cancer can cause exactly the same bleeding. When the bleeding is treated with ointments for months without an examination, the cancer has time to grow.

Piles and cancer can look alike

Piles typically cause bright red blood on the toilet paper or dripping into the pan after passing stools, often with straining or constipation. Bowel cancer can also cause bright red bleeding, especially cancer of the rectum. It can also cause darker blood mixed with the stool, or no visible blood at all.

You cannot tell the difference by looking. An examination is needed.

Warning signs

See a doctor if you have:

• Bleeding from the back passage, especially if you are over 40
• A change in bowel habit lasting more than three weeks: constipation, loose stools, or both
• A feeling that the bowel has not emptied completely
• Weight loss without trying
• Tiredness or breathlessness from low haemoglobin (anaemia)
• Pain or a lump in the abdomen

Your risk is higher if a parent, brother or sister has had bowel cancer.

What tests are done?

1. Examination of the back passage, which takes a few minutes in the clinic.
2. Colonoscopy: a thin camera examines the whole large bowel under sedation. Polyps can be removed during the same test, and biopsies taken from anything suspicious.
3. If cancer is found, CT and MRI scans show its stage and help plan treatment.

The good news

Colorectal cancer found early has a high chance of cure. Today, most patients with rectal cancer can have sphincter-sparing surgery, avoiding a permanent stoma bag, and many operations are done robotically or by keyhole surgery.

Bleeding is a symptom, not a diagnosis. If it keeps happening, get it examined.