Difference Between Hemorrhoids & Inflammatory Bowel Disease (IBD)

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoids and inflammatory bowel disease (IBD) are common diseases. Both affect the digestive tract, which is why it can be confusing to tell them apart. 

Despite sharing a few similarities, hemorrhoids and IBD are entirely different diseases and have different treatments. 

So in this article, we will look at what hemorrhoids are, what inflammatory bowel disease is, whether hemorrhoids are considered IBD, whether hemorrhoids can occur in IBD patients, and the treatments for both conditions.

What are hemorrhoids?

Hemorrhoids are swollen veins in the anal region. They are also known as piles.  

Veins carry blood away from the anus. When they are blocked, blood begins to pool inside and makes the veins appear swollen. 

Hemorrhoids can be divided into:

  • Internal hemorrhoids: These are found inside the anal canal
  • External hemorrhoids: These are found closer to the anal orifice and the skin. Sometimes, they may pop out of the anal canal. 

The first symptoms are often pain and bleeding during a bowel movement. You might also notice itching and swelling around the anal area if you have hemorrhoids.  

What is inflammatory bowel disease?

Inflammatory bowel disease is an autoimmune condition of the gut. This means the body’s immune system abnormally starts attacking its own tissue (the gut in this case). IBD is an umbrella term and is used to refer to two diseases — Crohn’s disease and ulcerative colitis.

While there are many differences between Crohn’s disease and ulcerative colitis, the location of inflammation is a good way to differentiate them.

Crohn’s disease can involve the entire digestive tract from mouth to the anus, and affects the deep layers of the walls of the gut. On the other hand, ulcerative colitis does not affect the whole digestive tract. Instead, it is limited to the colon and rectum, which are the terminal parts of your gut. 

The exact cause of IBD is still unknown. However, an abnormal immune system is the most likely mechanism behind the disease. 

A properly functioning immune system fights substances that are foreign to the body. In people who have IBD, the immune system responds incorrectly to environmental triggers and unintentionally damages the gut, leading to inflammation.

Symptoms of IBD include persistent diarrhea and stomach pain. In addition, patients may also experience joint pain, fever, bloody stools, eye inflammation, and liver disease. 

Are hemorrhoids considered inflammatory bowel disease?

Hemorrhoids are not considered IBD. Although both diseases affect the digestive tract, they are entirely different conditions. 

Here are three important differences between the two:

  • Hemorrhoids are seen as swollen veins around the anal canal. On the other hand, IBD does not affect the veins of the anus at all. Instead, it affects the walls of the digestive tract and doesn’t present as swelling in the anal area. Sometimes, Crohn’s disease can present as a peri-anal fistula, which is a small opening around the anal area. A tunnel forms which begins inside the anus and ends as a small opening outside of the anus. But this will be different from the swelling seen in hemorrhoids. 
  • Hemorrhoids have symptoms limited to the anus such as bleeding and pain while passing stool. On the other hand, IBD affects other parts of the digestive tract and has additional symptoms such as fever, weight loss, and mouth ulcers. 
  • Hemorrhoids are treated by surgical removal. However, treatment for IBD requires a careful combination of drugs and usually lasts years.

Can IBD patients develop hemorrhoids?

Yes, you can develop hemorrhoids if you have IBD. In fact, people with Crohn’s disease are more likely to develop hemorrhoids. 

That’s because some patients with Crohn’s disease can experience persistent constipation. This increases the pressure inside the body and compresses the veins in the anus, which leads to the development of hemorrhoids.

Hemorrhoids in Crohn’s can be treated like regular hemorrhoids (discussed later).

How to get rid of hemorrhoids?

Most small hemorrhoids go away on their own, but sometimes hemorrhoids last years. When they persist or become painful (especially if they are burst hemorrhoids), your doctor may offer you the following treatment options:

Band ligation

This is a relatively common treatment for internal hemorrhoids. The procedure uses a medical-grade rubber band (also called a ligator) that is placed tightly around the hemorrhoid.

The tight rubber band compresses the vessels that feed the hemorrhoid. This cuts off its blood supply, causing it to die. The dead hemorrhoid will fall off in around 3-10 days. 

Rubber band ligation is painless but you may feel a dull sensation for a day or two. There is no downtime to the procedure and you can resume your daily tasks almost immediately.

Photocoagulation

Photocoagulation — also called coagulation therapy — is commonly used for internal hemorrhoids. The surgeon uses infrared light to damage the hemorrhoid and create a scar.

This scar cuts off the blood supply to the hemorrhoid and causes it to die. The scar also holds other vessels firmly against the anal wall, which keeps them from hanging inside the anal canal in the future.

Unlike rubber band ligation, you might experience heat and pain during photocoagulation. Photocoagulation also treats a single hemorrhoid per visit. So people with more than one hemorrhoid need multiple visits, with approximately two weeks between each appointment. 

Sclerotherapy

Sclerotherapy uses a chemical that is injected into or around the hemorrhoid. The chemical damages the hemorrhoid and its blood supply, causing it to die. 

Sclerotherapy takes just a few minutes and causes only mild discomfort.

What is the treatment for inflammatory bowel disease?

Unlike hemorrhoid treatment, the treatment for IBD is longer and makes use of multiple medicines. These include anti-inflammatory drugs, immunosuppressants, biological agents, and antibiotics. Your doctor might also recommend dietary changes and surgery to control your disease. 

Anti-inflammatory drugs

These drugs are considered front line drugs for IBD. They are good at reducing the gut inflammation associated with the condition. Examples include corticosteroids and aminosalicylates. 

Your doctor will consider the site of the digestive tract that is affected and prescribe the relevant drug accordingly. 

Immunosuppressants

Because an unregulated immune system gives rise to IBD, suppressing it is a good way to treat IBD symptoms. Immunosuppressants reduce the production of white blood cells, dampening the damage they cause to the gut. Examples include azathioprine, mercaptopurine, and methotrexate. 

Unfortunately, these drugs can take up to 3 months to work and increase the risk of infections. 

Biological agents

This is a relatively new class of drugs that uses antibodies to reduce inflammation. Antibodies are protein molecules that can bind to white blood cells and prevent them from working properly.

Examples include infliximab, adalimumab, ustekinumab, and certolizumab.

Antibiotics

Many drugs used for IBD put you at an increased risk for infections, which is why your doctor might prescribe you an antibiotic as well.

Commonly prescribed antibiotics include ciprofloxacin and metronidazole. Interestingly, we have some evidence that suggests excessive antibiotic use can cause Crohn’s disease.

Others

In addition to the drugs described above, you also need medicines to control the symptoms of IBD. These include:

  • Anti-diarrheals: Diarrhea is a predominant symptom of IBD and must be treated to prevent dehydration and other complications. 
  • Painkillers: These are used to treat the stomach and joint pain seen in IBD.
  • Supplements: IBD can lead to poor absorption of nutrients, especially fat-soluble vitamins like vitamin A, D, E, and K. You might need supplements to prevent the long-term complications of nutrient deficiency. 

Surgery

When medicine and lifestyle changes fail to treat IBD, your doctor might offer you surgery. This involves removal of the affected parts of the gut. The ends of the remaining bowel are then joined together. 

Now you know how to tell hemorrhoids and inflammatory bowel disease apart

Remember, hemorrhoids and IBD are two completely different diseases. Hemorrhoids are swollen veins around the anal area, while IBD is an autoimmune condition that can affect the entire digestive tract. Knowing the do’s and don’ts of both is important for treatment.

The treatment for hemorrhoids includes lifestyle changes and procedures like band ligation, sclerotherapy, and photocoagulation. On the other hand, the treatment of IBD continues for longer periods and involves suppression of the immune system. This is done using drugs like steroids, biologics, and immunosuppressants.