What are the differences between hematochezia (rectal bleeding) and hemorrhoids?

Generally speaking, hematochezia (blood in stool) is a symptom, while hemorrhoids are a disease. They differ fundamentally and in terms of manifestations, mainly including differences in intrinsic properties, causes, blood characteristics, accompanying symptoms, and scope of impact. The main differences are as follows:

1. Different intrinsic properties: Hematochezia refers to blood being discharged from the anus and is one manifestation of various anorectal or systemic diseases; it is not an independent disease. Hemorrhoids are diseases caused by abnormal dilation of the venous plexus in the lower rectum or anal canal, and hematochezia is only one of the possible symptoms of hemorrhoids.

2. Different causes: Hematochezia can be caused by multiple factors. In addition to hemorrhoids, these include anal fissures, rectal polyps, rectal cancer, ulcerative colitis, etc. The mechanisms of hematochezia caused by different etiologies vary—for example, anal fissures result from tearing of the anal skin causing bleeding, whereas rectal cancer causes bleeding due to tumor ulceration. Hemorrhoid-related hematochezia mainly occurs when defecation causes fecal matter to rub against varicose venous masses, leading to venous rupture and bleeding.

3. Different blood characteristics: Hematochezia caused by hemorrhoids typically presents as bright red blood, usually not mixed with stool, manifesting as dripping or jet-like bleeding during defecation, and the bleeding often stops spontaneously after bowel movements. Hematochezia caused by other conditions varies in color and appearance—for example, hematochezia associated with anal fissures is accompanied by severe pain during defecation, while rectal cancer bleeding is often dark red in color, frequently mixed with stool, and may be accompanied by mucus or pus and blood.

4. Different accompanying symptoms: In addition to hematochezia, hemorrhoids may also be accompanied by anal itching, pain, and prolapse of hemorrhoidal masses. If the prolapsed hemorrhoidal mass cannot be reduced, significant swelling and pain may occur. When hematochezia is caused by other diseases, the accompanying symptoms vary—e.g., rectal polyps may present with prolapsing polyps, and ulcerative colitis may be accompanied by abdominal pain, diarrhea, and mucopurulent bloody stools.

5. Different scopes of impact: Hematochezia has a broad scope of possible causes, potentially arising from anorectal diseases, other gastrointestinal tract diseases, or even hematologic system diseases, making it a relatively broad symptom concept. Hemorrhoids are limited to venous abnormalities in the distal rectum and anal canal, and the hematochezia they cause is only one specific scenario among the broader symptom category.

In daily life, if hematochezia occurs, one can observe the characteristics of the blood and any accompanying symptoms, while also maintaining good bowel habits, avoiding prolonged sitting, and eating a light diet, all of which help reduce anorectal discomfort and maintain anorectal health.