Hemorrhoids vs Anal Fissures - Learn the Key Differences

Introduction

Rectal bleeding, pain, and itching are common symptoms that can signal a medical issue like hemorrhoids or anal fissures. But how do you know which one you're dealing with?

Hemorrhoids and anal fissures can seem similar at first glance. However, they have distinct differences in their causes, symptoms, risk factors, treatments, and potential complications.

Being able to identify hemorrhoids vs anal fissures allows you to seek the proper diagnosis and medical care. This guide covers everything you need to know about recognizing and treating these two common anal conditions.

What are Hemorrhoids?

Hemorrhoids, also called piles, are swollen and inflamed veins located in the rectum and anus. They are classified as either internal or external.

Internal Hemorrhoids

Internal hemorrhoids develop within the rectum beneath the lining. You typically can't see or feel them and they rarely cause pain. But they may bleed during bowel movements.

External Hemorrhoids

External hemorrhoids grow under the skin around the anus. They look like grape-shaped lumps and can be felt during daily activities. If a blood clot forms, they may appear blue and cause severe pain.

What Causes Hemorrhoids?

Hemorrhoids can stem from a variety of factors that place extra pressure on the veins in the rectum and anus, including:

Chronic constipation and straining

Forcing out hard, dry stools can put excessive strain on hemorrhoid veins and make them swell.

Pregnancy

Hormonal changes and extra pressure from the growing fetus commonly lead to hemorrhoids in pregnant women.

Obesity

Carrying excess weight can increase pressure in the lower rectum, causing hemorrhoids.

Heavy lifting

Lifting heavy objects frequently can also strain rectal and anal veins.

Diarrhea

Chronic diarrhea aggravates hemorrhoids by making you strain excessively when passing loose, watery stools.

Low fiber diet

A low fiber diet leads to small, hard stools that require pushing and straining to pass through the rectum.

Prolonged sitting

Sitting for long periods can pinch the blood vessels in the anus, triggering hemorrhoids.

Signs and Symptoms of Hemorrhoids

Some common signs and symptoms of hemorrhoids include:

Bright red blood on toilet paper or in the toilet bowl after a bowel movement

This is the most common symptom of internal hemorrhoids.

Lumps around the anus

External hemorrhoids may appear as bumps or swollen areas around the anus.

Pain and irritation around the anus

External hemorrhoids can be extremely painful if a blood clot develops in them.

Itching and discomfort around the anus

Hemorrhoids can cause itching, irritation, and swelling around the anus.

Leakage of feces

A prolapsed hemorrhoid may leak feces or mucus and cause dampness around the anus.

Difficulty cleaning after a bowel movement

Excessive straining can sometimes push a hemorrhoid through the anal opening, making it difficult to clean.

What is an Anal Fissure?

An anal fissure is a small tear or cut in the thin, moist tissue lining of the anus. Fissures typically develop in the midline of the anal opening, where most of the pressure occurs during bowel movements.

What Causes Anal Fissures?

Anal fissures often result from:

Passing hard or large stools

Forcing out dry, bulky stools can tear the delicate anal tissue and create a fissure.

Chronic diarrhea

Frequent bouts of watery diarrhea make the anal lining more vulnerable to tears with repeated wiping.

Constipation

Severe constipation with painful straining can also lead to tears in the anus.

Childbirth

Anal fissures commonly occur after vaginal childbirth, likely due to the passage of the infant and trauma to the area.

Anal sex

Forced anal sex or insertion of large objects may result in anal fissures.

Signs and Symptoms of Anal Fissures

The most common signs and symptoms of anal fissures include:

Sharp, severe pain during and after bowel movements

This is the hallmark symptom of most anal fissures.

Rectal bleeding

Anal fissures can cause mild to moderate bright red blood on the toilet paper, in the stool, and coating the stool.

Itching or burning sensation around the anus

Some anal fissures may produce a persistent itch or burning feeling after a bowel movement.

Visible anal tear

Acute anal fissures can sometimes be seen as an oval-shaped tear in the anal tissue.

Painful lump or skin tag

A sentinel pile may develop near the fissure, appearing as a lump of skin near the anal opening.

How to Tell the Difference: Hemorrhoids vs Anal Fissures

Despite some overlapping symptoms like rectal bleeding, hemorrhoids and anal fissures have distinct differences.

Here's an overview of how to tell them apart:

Pain

Hemorrhoids can be painless or cause mild discomfort, while anal fissures often cause severe cutting or burning pain during bowel movements.

Bleeding

Hemorrhoids lead to mild bleeding, usually just a few drops. Anal fissures can result in more substantial bleeding of bright red blood.

Location

Hemorrhoids form inside the rectum or protrude near the anal opening. Anal fissures occur directly in the groove-like anal opening.

Appearance

Protruding hemorrhoids look like clumps of swollen skin, while anal fissures appear as actual tears in the tissue lining the anus.

Duration

Hemorrhoids are a chronic condition. Anal fissures are acute tears that can heal within a few weeks.

Causes

Hemorrhoids have a range of causes, but anal fissures almost always result from passing hard or large stools.

Risk factors

Common hemorrhoid risk factors like obesity and pregnancy rarely lead to anal fissures.

Medical Treatments for Hemorrhoids

Several medical treatment options exist for hemorrhoids based on their severity. Treatments for internal hemorrhoids include:

Improving bathroom habits

Increasing fiber, staying hydrated, and avoiding straining can help manage symptoms.

Over-the-counter remedies

Creams, ointments, medicated wipes, and suppositories can provide temporary relief of irritation and swelling.

Office-based procedures

Procedures like sclerotherapy, infrared coagulation, and rubber band ligation can eliminate small hemorrhoids.

Surgery

For severe internal and external hemorrhoids that don't respond to other treatments, surgical removal may be recommended.

Medical Treatments for Anal Fissures

Mild anal fissures often heal quickly with simple at-home treatments. Severe, chronic fissures may require prescription medications or surgery.

Topical nitroglycerin

Nitroglycerin cream relaxes the anal muscle to allow tearing to heal. It is typically used for 4-8 weeks.

Calcium channel blockers

Pills help relax the anal sphincter muscle and increase blood flow to promote healing of chronic fissures.

Botox injections

Botox can temporarily paralyze the anal sphincter to allow the fissure to heal. The effect lasts about 8 weeks.

Surgery

For severe, recurrent fissures, surgery can cut a portion of the anal sphincter to reduce spasms and promote healing.

Home Remedies and Lifestyle Changes

There are also several natural remedies and lifestyle adjustments that may provide relief from hemorrhoids and anal fissures:

Increase fiber intake

Eating more high fiber foods like fruits, vegetables, beans, and whole grains softens stool for easier passing.

Stay hydrated

Drinking adequate water and fluids keeps stools soft to minimize straining during bowel movements.

Take warm baths

Sitting in a warm bath for 10-15 minutes can reduce swelling and discomfort from hemorrhoids and anal fissures.

Try topical agents

Applying coconut oil, aloe vera, honey, or witch hazel may soothe irritated anal tissues.

Consider supplements

Some supplements like psyllium husk, zinc oxide, and plant oils can support anal and rectal health.

Avoid irritants

Limit toilet paper use and refrain from scratching to prevent further irritation and damage.

Complications of Hemorrhoids and Anal Fissures

Without proper treatment, hemorrhoids and anal fissures can sometimes lead to complications like:

Anemia

Chronic blood loss from hemorrhoids or fissures may cause anemia, or low red blood cell count.

Infection

Bacteria entering broken skin from severe fissures or hemorrhoids can lead to an abscess or widespread infection.

Sphincter damage

Long-term anal fissures may damage the anal sphincter muscle, causing fecal incontinence.

Anal fistula

An abnormal tunnel connecting the anus and skin may form from an infected anal fissure or hemorrhoid.

Skin tags

External hemorrhoids that heal may leave behind skin tags that don't go away without removal.

Prevention Tips

You can reduce your risk of developing hemorrhoids or anal fissures by:

• Eating a high fiber diet with lots of vegetables, fruits, and whole grains
• Drinking plenty of water each day to stay hydrated
• Avoiding extended sitting on the toilet
• Being gentle and avoiding aggressive wiping after bowel movements
• Not delaying when you feel the urge to have a bowel movement
• Treating chronic constipation or diarrhea promptly
• Practicing healthy bowel habits to avoid straining

When to See a Doctor

Consult your doctor if you experience:

• Severe or persistent pain not relieved by over-the-counter remedies
• Bleeding that continues for more than 1-2 weeks
• Frequent recurrence of symptoms
• Changes in bowel habits lasting more than a few days
• Signs of infection like fever, increased pain, or pus/discharge
• Difficulty controlling bowel movements

The Bottom Line

Hemorrhoids and anal fissures share some similar symptoms but have important differences. Hemorrhoids are swollen veins that may bleed mildly and irritate the anus. Anal fissures are actual tears in the anal lining that cause severe pain and bleeding.

Hemorrhoids result from increased pressure on the rectal veins. Anal fissures typically stem from passing hard or large stools. Distinguishing between these two anal conditions allows for an accurate diagnosis and targeted treatment plan.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.