Determining whether an itchy or uncomfortable anal lump is anus warts vs hemorrhoids can be difficult. At the initial onset, when it is most important, the two can appear and feel quite similar.
However, there are telling differences in both appearance and signs and symptoms. Because they have very different treatments, achieving clarity on whether you have anus warts or hemorrhoids is essential.
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Hemorrhoids, also known as piles, are swollen blood vessels in the anal canal. There are several types of hemorrhoids:
Internal, located inside the anus
External, located on or around the anus
Prolapsed, when an internal hemorrhoid protrudes out of the anus, often due to strain
Hemorrhoids are thought to stem from repetitive straining related to chronic constipation or diarrhea, leading to the disruption of the supporting tissue elements with subsequent elongation, dilation, and engorgement of the hemorrhoidal tissues. Hemorrhoids occur more frequently in older populations.
Anal warts (condylomata acuminata) are caused by human papillomavirus (HPV), a sexually transmitted disease (STD) that, depending on the type, can also lead to cancerous lesions. The warts initially appear as small spots that can grow large enough to cover the entire anus or genitals in rare cases. The growths are highly contagious and occur through direct contact with infected skin or mucosa.
Pain and itching are common hemorrhoid symptoms, which can be unbearable, especially during bowel movements. Some are not painful, and because hemorrhoids can vary in location and type, the exact symptoms will also differ.
Internal hemorrhoids are typically not painful unless they prolapse. However, they can bleed, causing bright red blood in one's stool, in the toilet bowl, or on wiping.
One of the most common signs of anal warts is the presence of soft and moist pink or light-brown bumps that resemble cauliflower. Visible anogenital warts can ultimately enlarge, have rough surfaces, cluster, or become pedunculated. As they are often painless, it's common for anal warts to go unnoticed, although they can be itchy.
Left untreated, most anal warts resolve spontaneously, and treatment is not always indicated. However, rarely, some HPV infections may lead to genital cancers.
Because the treatments for anus warts and hemorrhoids are vastly different, it's beneficial to identify them early on.
Anal warts can easily spread, and it's easier to prevent this when they’re small. Hemorrhoids are usually associated with minimal pain and can be treated easily. Both anal warts and hemorrhoids can bleed, making it difficult sometimes to differentiate between anal warts vs hemorrhoids.
Anal wart treatment includes creams and also liquid nitrogen, which may be painful on an already aggravated area. It’s important to receive an accurate diagnosis before treatment so you don't use potentially aggravating anal warts treatments on hemorrhoids.
The best way to be sure is to get a professional diagnosis, and an experienced physician can diagnose anal warts clinically. At times, they might perform a biopsy to confirm the diagnosis. Hemorrhoids can be diagnosed by physical examination as well. In either case, the doctor may use an anoscope (lighted scope) to check for internal anal warts or hemorrhoids.
There are four main treatments for anal warts:
Topical creams (Podofilox, Imiquimod, Sinecatechin)
Cryotherapy (freezing them; administered by your doctor)
Trichloro- or bichloroacetic acid administered by your doctor to burn the warts
The right treatment depends on the severity, size, and location of the anus warts. Generally, treatments for small and localized anal warts include applying a topical cream or liquid nitrogen, and about a third of anogenital warts regress without treatment within four months.
For large anal warts or those deeper inside the anus, surgery is an option. The extent of the surgery determines whether the patient must be completely anesthetized or if the area can simply be numbed during the procedure. If there are many warts in different spots near the anus and in the rectum, the surgery may need to be performed in multiple stages. In any case, most anal wart surgeries require only a day in hospital, and usually no overnight hospital stay is necessary.
Be aware that warts can return, and following up is very important. Human papillomavirus (HPV) may recur, creating new warts, especially if the area is inflamed or irritated or if the patient is immunocompromised.¹
Most hemorrhoids usually disappear on their own in a couple of weeks. Most treatments involve home care rather than treatment in a clinical setting. As they are enlarged blood vessels, one of the most important treatments for hemorrhoids is to reduce strain during defecation.
The main ways of reducing strain to the anus and rectal area are to avoid constipation by:
Ensuring adequate hydration
Having a high fiber intake
Using laxatives if required
Sitz baths are another common treatment option, which relax the anal muscles. Soothing wipes, especially those containing witch hazel or aloe vera, can also be helpful, as are over-the-counter creams or internal suppositories. The ingredients for both often contain hydrocortisone, an anti-inflammatory, and lidocaine, which numbs the area.
When prolapsed, the anal sphincter can cut off blood flow to hemorrhoids. This can cause tremendous pain, and some prolapsed hemorrhoids might require surgery.
If hemorrhoids persist for longer than 7–10 days, it could be another issue, and you should seek a more accurate diagnosis.
To ensure proper treatment, confusion over anal warts vs hemorrhoids must be cleared up as early as possible. You should seek the appropriate therapies to either halt the spread of anal warts or, for hemorrhoids, begin soothing the enlarged blood vessels and reducing strain.
If you are certain it's anal warts, consult your doctor for early diagnosis and treatment. For hemorrhoids, you can start by treating them at home — but if you experience other complications, you are advised to seek medical advice. Lumps that aren't gone after a week and bleeding more than a few drops are signs to see a doctor. Other possible causes of anal lesions or lumps include rectal ulcers, fistulas, or other lower digestive tract issues.
At first, it can be hard to differentiate between anus warts vs hemorrhoids, as they both begin as small lumps in or around the anus. They can also both feel itchy, while hemorrhoids are more often painful (although not always). It's easier to tell the difference when the condition has progressed, but by then, it may be much harder to treat.
Fortunately, there are several highly effective treatments for either condition. However, selecting the appropriate treatment requires differentiating between the two first.
The nature of haemorrhoids (1975)
What causes anal cancer? | American Cancer Society
Symptoms & causes of hemorrhoids | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Anal warts | American Society of Colon and Rectal Surgeons
Diagnosis of hemorrhoids | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Suppositories for hemorrhoids treatment | Hemorrhoids.org