Anal fissures and haemorrhoids are two common conditions that affect the anorectal region, causing discomfort and concern for many individuals. Though they share many similarities, such as their location and some symptoms, they have distinct causes, symptoms, and treatments.
This article explains the differences between anal fissures and haemorrhoids and the best way to manage and treat each condition.
What Is An Anal Fissure?
An anal fissure is a small, linear tear or cut in the mucosa of the anal canal. These tears typically result from the stretching of the anal mucosa beyond its capability, often due to passing large or hard stools or other forms of trauma such as childbirth or anal intercourse.
This condition is characterised by severe pain and bleeding, especially during and shortly after bowel movements.
Symptoms:
- Sharp, intense pain during bowel movements, sometimes lasting hours after.
- Bright red bleeding visible on toilet paper or stool.
- A visible tear or cut in the skin around the anus.
Risk Factors:
- Chronic constipation or diarrhoea: Repeated straining and prolonged irritation can lead to fissures.
- Childbirth: Women are at higher risk postpartum due to the pressure and stretching during delivery.
- Inflammatory bowel disease: Conditions like Crohn’s disease can make one more susceptible.
- Tight anal sphincter muscles: Can reduce blood flow to the anorectal area, making the tissue more prone to tearing.
- Age: Infants are prone to fissures, but they can occur at any age.
What Are Haemorrhoids?
Also called piles, haemorrhoids are swollen veins found in the rectal area. They can develop inside the rectum (internal haemorrhoids) or under the skin around the anus (external haemorrhoids).
Haemorrhoids are primarily caused by increased pressure in the lower rectum because of straining during bowel movements, prolonged sitting or standing, obesity, pregnancy, or a low-fibre diet.
Symptoms:
- Itching or irritation in the anal region.
- Pain and discomfort while sitting or during bowel movements.
- Swelling around the anus.
- Painless bleeding during bowel movements
Risk Factors:
- Age: As people get older, the supporting tissues in the rectum and anus can stretch and weaken, leading to an increased risk of developing haemorrhoids.
- History of Chronic constipation or diarrhoea: Straining during bowel movements is a primary cause of haemorrhoids.
- Pregnancy: The weight of the foetus can cause haemorrhoidal vessels to enlarge, along with hormonal changes. Delivery also increases pressure in these vessels.
- Prolonged sitting: Staying seated for long periods, especially on the toilet, can increase the pressure on the veins in the anus and rectum.
- Obesity: Excess weight, particularly around the midsection, can increase pressure on the pelvic veins.
- Diet: A low-fibre diet can lead to constipation, resulting in straining during bowel movements.
Distinguishing Between Haemorrhoids Vs Anal Fissures
When trying to distinguish between haemorrhoids vs anal fissures, consider the nature and location of the pain, the bleeding pattern, and any additional symptoms like itching or the presence of lumps.
Here’s a deeper look into how to differentiate the two based on pain type, bleeding patterns, and other symptoms:
1. Appearance
- Anal fissures: They are small tears that appear as linear or oval-shaped ulcers in the posterior midline of the anus. They can be hard to see without proper positioning and lighting. Rarely, they can be found anteriorly or on the sides.
The fissure can look like a fresh, red tear or a chronic, deeper ulcer with defined or raised edges. Swelling and redness may occur in the surrounding tissue if the area is irritated or infected. A sentinel pile, a tag of skin at the distal end of the fissure, can also sometimes be observed.
- Haemorrhoids: Internal haemorrhoids are not visible externally although they may prolapse and protrude outside the anal canal. External haemorrhoids appear as lumps or swelling around the anal rim and can be felt as bulges at the anal opening. Haemorrhoids can be body-coloured, slightly redder, or blueish if thrombosed.
2. Type of Pain
- Anal Fissures: The pain associated with anal fissures is typically acute and intense. It occurs during bowel movements as the stool passes the tear, causing a sharp, searing pain that can be quite severe and may be accompanied by minimal bleeding.
The pain might continue for several hours after defecation, often described as feeling like passing glass shards. Fissures can also cause a spasm of the anal sphincter, further intensifying the pain.
- Haemorrhoids: In contrast, haemorrhoids generally cause a duller, throbbing pain, especially when they are external and become thrombosed or prolapsed.
The discomfort might increase while sitting or during bowel movements but doesn’t usually reach the acute intensity of fissure pain. Internal haemorrhoids might not be painful unless they prolapse or become thrombosed.
3. Bleeding Patterns
- Anal Fissures: Bleeding is a common symptom associated with anal fissures. When an anal fissure occurs, the small tear or crack in the lining of the anus can result in bright red blood during or after a bowel movement. This bleeding is typically minimal, but it can be noticeable on toilet paper or in the toilet bowl.
- Haemorrhoids: Haemorrhoids can also cause bright red bleeding, but the pattern might differ. Internal haemorrhoids often lead to painless bleeding that might be noticed as streaks on the stool or pooling in the toilet bowl. External haemorrhoids, especially when they rupture or are thrombosed, can bleed significantly and sometimes clotted blood may be noticed.
4. Itching And Discomfort
- Anal fissures: Don’t typically cause itching but can lead to significant discomfort due to the spasm of the anal sphincter muscle. These spasms can result in sharp, stabbing, or burning pain during or after bowel movements, making it uncomfortable for individuals with anal fissures to pass stools.
- Haemorrhoids: They can often lead to itching and skin irritation around the anal area, mainly when they are external, and cause swelling and inflammation of the surrounding skin.
What Happens If Anal Fissures Or Haemorrhoids Are Left Untreated?
If left untreated, both anal fissures and haemorrhoids can lead to more serious complications. Anal fissures can develop into chronic pain, deeper fissures, and increased risk of infection.
Individuals may start avoiding going to the bathroom due to the pain, leading to constipation or impacted stools, which can exacerbate the problem.
Similarly, if left untreated, haemorrhoids can cause various complications, such as anaemia, become thrombosed, prolapsed haemorrhoids, skin tags, and infection.
Prolapsed haemorrhoids can stretch and bulge outside the anus, while thrombosed haemorrhoids can be very painful and may require surgical intervention.
Additionally, external haemorrhoids that are left untreated can lead to excess, saggy skin around the anus, known as skin tags, which can cause hygiene issues and further irritation.
Diagnosing Anal Fissure Vs Haemorrhoids
The accurate diagnosis of anal fissures and haemorrhoids involves a physical examination and other procedures by a healthcare professional. Here’s how each condition is generally diagnosed:
Anal Fissures
- Visual Inspection: A doctor will look for visible signs of a tear in the lining of the anal canal. This is often evident as a small cut or ulcer, usually located posteriorly in the midline.
- Digital Rectal Exam (DRE): This might be avoided if there’s severe pain, as it can be quite uncomfortable.
- Anoscopy: A small, lighted tube (anoscope) may be used to view the anal canal more clearly. However, this might not be possible in acute fissures due to pain.
Haemorrhoids
- Physical Examination: External haemorrhoids can often be seen or felt as swollen lumps around the anus. Internal haemorrhoids may not be apparent until they prolapse.
- Digital Rectal Exam (DRE): During DRE, the doctor may feel for abnormalities inside the rectum.
- Anoscopy or Proctoscopy: These tools are often used to view internal haemorrhoids or other causes of bleeding within the rectum.
Treatment Of Anal Fissures And Haemorrhoids
The treatment for haemorrhoids and anal fissures involves both conservative measures and, if necessary, more invasive medical procedures. Here’s an overview of the typical treatment approaches:
Anal Fissures
The treatment goals for anal fissures aim to provide relief from symptoms, promote healing, and prevent the recurrence of the conditions. Options include:
- Topical Creams: Nitroglycerin ointment or other topical creams are prescribed to help relax the muscle around the anus (the internal anal sphincter), improving blood flow to the area and facilitating healing.
- Warm Baths: Sitting in a few inches of warm water (sitz baths) several times a day can relax the sphincter muscle and promote healing.
- Dietary Changes: Doctors may suggest increasing fibre intake and fluid consumption to soften stools and reduce strain on the fissure.
- Stool Softeners: These may be recommended to reduce straining during bowel movements.
- Surgery: In cases where conservative treatment fails, a surgical procedure known as lateral internal sphincterotomy may be performed to help reduce sphincter spasms and promote healing.
Haemorrhoids
These haemorrhoid treatments can help relieve symptoms like pain, itching, bleeding, and discomfort, reducing swelling and promoting healing of hemorrhoidal tissue, while also preventing recurrence and addressing complications when necessary.
- Over-the-counter Creams and Suppositories: These can reduce itching, pain, and swelling. They often contain ingredients like hydrocortisone or witch hazel.
- Cold Packs: To reduce swelling and pain, ice or cold packs must be applied to the area regularly.
- Sitz Baths: Just like with fissures, warm water baths can provide relief from itching and discomfort.
- Dietary Changes: Increasing fibre intake can prevent constipation, reducing the strain and pressure on haemorrhoids.
- Minimally Invasive Procedures: For persistent or severe haemorrhoids, a doctor may perform rubber band ligation, sclerotherapy, or infrared coagulation to reduce or eliminate haemorrhoids.
- Surgery: In severe cases, haemorrhoidectomy (removal of haemorrhoid) or haemorrhoid stapling may be necessary.
When To Seek Medical Help
Anal fissures and haemorrhoids can sometimes resolve on their own, especially if they are mild and appropriate lifestyle modifications are made. However, the healing process and likelihood of self-resolution depend on several factors, including the severity of the condition, underlying causes, and individual health and diet.
There are specific situations in which it’s advisable to seek medical help for either condition:
- Persistent Symptoms: If you have symptoms of an anal fissure, such as pain, bleeding, or discomfort, and they persist for more than a few days despite self-care measures, it’s a good idea to consult a healthcare provider. If you have haemorrhoid symptoms (pain, itching, bleeding, or swelling) that persist for more than a week despite self-care measures, consult a healthcare provider.
- Severe Symptoms: If the pain associated with the anal fissure is severe, does not improve with over-the-counter pain relief, or interferes significantly with your daily life, a medical evaluation is recommended. Meanwhile, severe pain, excessive bleeding, or prolapsed haemorrhoids (when internal haemorrhoids protrude through the anus) require medical evaluation.
- Frequent Recurrence: If you have recurrent anal fissures or haemorrhoids, seeking medical attention can help identify underlying causes and develop a long-term management plan.
- Signs of Infection: If you notice signs of infection around the anal fissure, such as increased pain, redness, swelling, or the presence of pus, prompt medical attention is necessary.
- Concerns About Cancer: In rare cases, rectal bleeding can be a sign of colorectal cancer. If you have significant rectal bleeding or bleeding associated with other concerning symptoms (such as unexplained weight loss or changes in bowel habits), it’s essential to seek prompt medical attention.
In both cases, your healthcare provider can perform a thorough evaluation, confirm the diagnosis, and recommend appropriate treatments.
Conclusion About Anal Fissures Vs Haemorrhoids
Anal fissures and haemorrhoids are two different conditions with different treatments and symptoms. Learning more about these conditions can prevent future occurrences and treat any symptoms effectively.
Remember, when in doubt, seek professional medical advice to get the correct diagnosis and treatment plan. At Advanced Colorectal And General Surgery, your comfort and health are our priority.
Our specialist is experienced in performing advanced surgical procedures related to the colon, rectum, and other general surgical conditions. We strive to provide the most effective and personalised treatment options to ensure the best possible outcomes for our patients. Book an appointment today!
Frequently Asked Questions About Anal Fissures Vs Haemorrhoids
Can I Still Poop If I Have Anal Fissures Or Haemorrhoids?
Yes, you can still poop with anal fissures or haemorrhoids, but it may be uncomfortable or painful. To ease discomfort, it’s important to keep stools soft and regular through a high-fibre diet, plenty of hydration, and possibly the use of stool softeners.
How Long Do Anal Fissures And Haemorrhoids Typically Take To Heal?
Acute fissures may heal within a few weeks with proper care. Chronic fissures might take longer and require medical treatment. For haemorrhoids, the healing time can vary. Mild haemorrhoids may improve within a few days, while more severe cases might take a few weeks and could recur or require medical intervention.
Are Anal Fissures And Haemorrhoids More Common At A Certain Age?
Both conditions can occur at any age but are more commonly seen in adults due to factors like increased pressure from long-term sitting, dietary habits, and, in the case of haemorrhoids, ageing-related weakening of the tissues.
Can Anal Fissures And Haemorrhoids Occur Simultaneously?
Yes, it is possible to have both anal fissures and haemorrhoids at the same time. These conditions can share similar symptoms, and a healthcare provider can help differentiate between them.
