Piles vs bowel cancer symptoms: what overlaps and what needs checking

Blood on the toilet paper or in the pan is alarming, and piles are the explanation most people reach for first. That is reasonable, since piles are common. The NHS describes piles as swollen blood vessels in and around the anus and lists bright red blood after you poo as one of their main symptoms.

The difficulty is that bleeding from the bottom is also one of the symptoms of bowel cancer. Bowel cancer, as the NHS defines it, is cancer found anywhere in the large bowel, which includes the colon and rectum, and it is one of the most common cancers in the UK. Bowel Cancer UK says bowel cancer can affect anyone, whatever their age, gender, ethnicity or where they live.

So the same observation, blood, can have more than one explanation. Because of that, the useful question is not "is this piles or cancer?" but "does this fit a settled, explained pattern, or is something new or different happening?"

The table draws on the NHS pages for piles and for bowel cancer symptoms, and the Bowel Cancer UK symptoms page. It shows overlap as well as differences, and it is not a self-diagnosis tool.

Piles tend to produce local symptoms around the anus. Symptoms that involve the rest of the bowel or the whole body are the ones that should raise the question of something else. The NHS lists these for bowel cancer: a change in your poo that is not usual for you, needing to poo more or less often, blood in your poo that may look red or black, tummy pain, a lump in your tummy, bloating, losing weight without trying, and feeling very tired or short of breath, which can be signs of anaemia.

Bowel Cancer UK explains that bright red blood may come from piles or polyps, while dark red or black blood may come from the bowel or stomach. It also says there is no rule for how often you should go to the toilet, and that the important thing is to know what is normal for you and to tell your GP about changes. It adds that you may not have all the symptoms, and that even one symptom is enough for your GP to want to see you.

The NHS piles page itself says to see a GP if you notice a change around your anus that is not normal for you, and to ask for an urgent GP appointment or NHS 111 help if you have painless bleeding from the bottom. A GP is described as possibly checking that your symptoms are not being caused by something else.

The NHS bowel cancer symptoms page gives three tiers. See a GP if you have any symptoms of bowel cancer, and try not to be embarrassed because the doctor or nurse will be used to talking about these symptoms. Ask for an urgent GP appointment or get help from NHS 111 if your poo is black or dark red or you have bloody diarrhoea. Call 999 or go to A&E if you are bleeding non-stop from your bottom, or there is a lot of blood or you see large blood clots when you poo.

Bowel Cancer UK adds a separate warning. A tumour can sometimes block the bowel, causing sudden strong stomach pains, bloating and feeling or being sick, with an inability to poo or pass wind. It says that if you think you have a bowel obstruction, are in a lot of pain, or are feeling very unwell, call NHS 111 for advice or go to a hospital accident and emergency department.

The NHS piles page gives its own emergency tier: go to A&E or call 999 if you have piles and you are bleeding non-stop, there is a lot of blood or large blood clots, or you are in severe pain.

The NHS says the doctor will ask about your symptoms, general health, medical history and whether anyone in your family has had bowel cancer. Depending on your symptoms, the doctor may feel your tummy and ask to carry out a rectal examination, where a gloved finger is placed inside the bottom to check for lumps. You can ask for a male or female doctor or nurse, and for someone else to be in the room.

You may be asked for a stool sample, or given a home FIT kit to collect a small sample and send it to a lab. The NHS says these tests check whether you are bleeding from your bowel. You may also be asked to have a blood test. If the GP thinks you have symptoms that could be cancer, you may get an urgent referral for more tests or to see a specialist, which the NHS stresses does not definitely mean you have cancer.

Bowel Cancer UK suggests keeping a note of your symptoms before the appointment and offers a symptoms diary for that purpose. It says that knowing when symptoms started and how they change helps your GP decide which tests to do.

If the cause is piles, the NHS says they often get better on their own after a few days, and lists things you can do: gently push a pile back inside if you can, take paracetamol if piles hurt, use an ice pack wrapped in a towel, drink plenty of fluids and eat plenty of fibre, take a warm bath, keep the area clean and dry, and cut down on alcohol and caffeine to avoid constipation. It advises not to push hard when pooing, not to ignore the urge to poo, and not to take ibuprofen if piles are bleeding.

A pharmacist can suggest creams for pain, itching and swelling, and laxatives. If home treatment does not help, hospital treatments include rubber band ligation, sclerotherapy, electrotherapy, infrared coagulation or surgery. None of this is a reason to delay a check if your symptoms include any of the changes described above.