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What is the Difference Between a Hemorrhoid and Anal Fissure?

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. … You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

What is the difference between a hemorrhoid and a fissure?

What is the difference between anal fissures and piles? … An anal fissure is a small tear or ulcer (open sore) in the skin just inside your anus. Whereas piles, also known as hemorrhoids, are swollen veins and surrounding tissue around your anus or in your back passage.

What are the signs and symptoms?

  • With internal hemorrhoids, the only symptom may be rectal bleeding. Bright red blood may appear as streaks on toilet paper or stool, or bright red blood that drips into the toilet following bowel movements. Other symptoms include a lump that can be felt around the anus with or without associated pain (usually from external hemorrhoids), or itching or mucus discharge after bowel movements. Hemorrhoids generally last several days and often recur.
  • Anal fissures often cause pain during and after a bowel movement, sometimes followed by throbbing pain for several hours. They are also often associated with itching and blood on toilet tissue, in the bowl, or on the surface of the stool.

What exactly are they?

  • Hemorrhoids, or “piles,” are swollen or dilated veins of the rectum or anus. Hemorrhoids may be located just inside the anal canal (internal hemorrhoid), or surrounding the anal opening (external hemorrhoids). Hemorrhoids may be present for years but go undetected until bleeding occurs.
  • Anal fissures are tears of the sensitive mucosal lining of the anus.

What causes them?

Hemorrhoids are presumed to be caused by repeated pressure in the anal and rectal veins. Anal fissures are caused by trauma to the anal canal usually during bowel movements. Anal fissures are also sometimes caused by inflammatory bowel disease or infection. Other contributing factors include constipation, excessive straining during bowel movements, prolonged sitting, pregnancy, obesity, loss of muscle tone due to old age, rectal surgery or episiotomy, alcoholism with cirrhosis (liver disease), anal infection, anal intercourse, and colon malignancy.


Diagnosis is usually made by taking a careful history and examination of the anal area, which may include an anoscopy (visual examination of the anus by means of a short tube called an anoscope). Sometimes patients are referred to a colorectal surgeon or gastroenterologist who may perform a sigmoidoscopy (a method of examining the rectum and lower part of the colon using an optical instrument with a lighted tip).

What does surgery for an anal fissure involve?

Before surgery is considered, your doctor will re-examine you and may conduct other tests to determine why other treatments have failed to heal the fissure.

A fissure may fail to heal because of scarring or muscle spasms of the internal anal sphincter muscle. Surgery usually consists of making a cut to a small portion of the internal anal sphincter muscle to reduce pain and spasms and allow the fissure to heal. Cutting the muscle rarely results in the loss of ability to control bowel movements.

The surgery can usually be performed on an outpatient basis (the patient goes home the same day). Pain is relieved after a few days and complete healing takes place in a few weeks.


The key to prevention is proper diet and habits to produce softer stools, thus reducing the need to strain.

  •  Add plenty of fiber to diet (fruits, vegetables, legumes, and whole grains).
  • Drink plenty of fluids (8 to 10 glasses of water daily).
  • Don’t hurry or strain to push bowel movements, but avoid prolonged toilet sitting.
  • Avoid vigorous wiping after bowel movements (to decrease irritation).
  • Lose weight, if overweight.
  • Exercise regularly.
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