Rectal bleeding, pain, lumps, or discomfort around the anus can cause concern. While these symptoms are commonly linked to haemorrhoids (piles), a benign condition, they can sometimes indicate anal cancer—a rarer but more serious disease. Both share similar signs, which can lead to misdiagnosis or delayed treatment. Key differences often include persistent pain, hard or irregular lumps, bleeding unrelated to bowel movements, and changes in bowel habits. Risk factors such as HPV infection, smoking, and weakened immunity increase vulnerability. Recognising warning signs early and consulting a doctor promptly is essential for accurate diagnosis and effective treatment.
Understanding the difference between the causes and symptoms of piles and anal cancer
Hemorrhoids (Piles)
Hemorrhoids (often called piles) are swollen or inflamed vascular structures in the lower rectum and anal canal. In their normal state, these vascular cushions help with stool control, but when they become engorged with blood, they enlarge and cause symptoms.
They are broadly classified into:
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Internal hemorrhoids: Occur inside the rectum, usually painless unless they prolapse or become irritated.
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External hemorrhoids: Located under the skin around the anus, often painful, especially when thrombosed (clotted).
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Prolapsed hemorrhoids: Internal hemorrhoids that protrude through the anus.
Common causes and risk factors include: chronic constipation, straining, prolonged sitting on the toilet, pregnancy, obesity, low-fibre diet, and repeated heavy lifting.
Typical symptoms of hemorrhoids
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Bright red bleeding during or after bowel movements
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Itching, irritation, or burning around the anus
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A lump or swelling near the anus (especially external or prolapsed hemorrhoids)
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Mucus discharge
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Discomfort or pain, particularly with external hemorrhoids
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Occasionally, a sense of fullness or incomplete evacuation
These symptoms often wax and wane; flare-ups may resolve with conservative treatments like increased fibre, hydration, sitz baths, topical agents, or minimal procedures.
Anal cancer
Anal cancer is a malignant growth originating in the tissues of the anus (the distal canal through which stool passes). It results from abnormal cell growth, often in the lining of the anal canal. It is relatively rare compared to many other cancers, but it requires prompt diagnosis and treatment when it is present.
Types and risk factors
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Squamous cell carcinoma is the most common type of cancer.
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Other types include adenocarcinoma, small cell carcinoma, and melanoma (less frequent).
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Risk factors include infection with human papillomavirus (HPV), human immunodeficiency virus (HIV), smoking, multiple sexual partners, receptive anal intercourse, prior anal warts, weakened immune system, and history of other genital cancers.
Symptoms of anal cancer
Many symptoms overlap with haemorrhoids but tend to persist, worsen, or differ in nuance. Key red flags may include:
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Persistent or recurrent anal or rectal bleeding, sometimes darker or mixed with stool
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A mass, lump, or thickening around the anus (which may feel firmer or fixed)
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Anal or pelvic pain or pressure (not just discomfort during bowel movement)
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Changes in bowel habits (diarrhoea, constipation, narrowing of stool)
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Mucus or pus discharge
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Sensation of incomplete evacuation
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Unexplained weight loss, fatigue, or systemic symptoms (less common in early stages)
Because anal cancer can grow and invade tissues, its symptoms may not respond to typical haemorrhoid treatments or may gradually worsen.
Overlapping symptoms of anal cancer and piles: Why confusion occurs
Because both hemorrhoids and anal cancer affect the same region, there is significant overlap in symptoms:
Bleeding from the anus or rectum
A lump or swelling in or near the anal region
Pain or irritation
Mucus discharge
Indeed, according to a study published in the
Journal of Investigative Medicine High Impact Case Reports, doctors initially misdiagnose anal cancer as hemorrhoids in a substantial fraction of cases. One reason is that haemorrhoids are far more common and easier to suspect.
However, important distinctions lie in the duration, quality, response to treatment, and accompanying signs.
When to see a doctor
If symptoms such as rectal bleeding, pain, or lumps persist beyond a few weeks, or if they fail to improve with standard hemorrhoid treatments, medical evaluation is essential. A doctor may perform a physical examination, anoscopy, or colonoscopy, and, if necessary, a biopsy to confirm the diagnosis.
Early detection of anal cancer significantly improves treatment outcomes, while timely management of hemorrhoids prevents chronic discomfort or complications.
