Anal Fissures vs. Hemorrhoids: The Difference & Treatment Options

Anal Fissures vs. Hemorrhoids: The Difference & Treatment Options

If your rear is sore and uncomfortable, I feel your pain. This problem is certainly an unpleasant one, and the sooner you can get it resolved, the better.

The question is: What's causing the discomfort? Read on to learn about anal fissures vs. hemorrhoids to get a handle on which is giving you trouble. Then, find out what you can do to find relief.

Anal Fissures: Small Tears

Unusual bowel movements, including hard stools and diarrhea, can cause the tender lining of the anus to tear. These tears are called anal fissures. In addition to constipation and diarrhea, other risk factors for fissures include having inflammatory bowel disease, being overweight or being of an advanced age.

Anal fissures are painful. They especially hurt when passing stool, and the pain can last for hours afterward. It is often experienced as a throbbing sensation.

Fissures can also itch uncomfortably. Plus, you may notice blood when you wipe or spot blood in the toilet bowl.

To see a diagram of a fissure, watch the video "Anal Fissure--3D Medical Animation."

Hemorrhoids: Swollen Vessels

Unlike a fissure, a hemorrhoid is a swollen blood vessel. The inflamed vessel becomes large and uncomfortable.

Hemorrhoids can be internal or external. The external ones are outside of the anal opening. They usually appear as dark bumps on the skin. These can bleed, and they are often painful.

Internal ones are classified into four levels, also known as grades.

  • Level one is usually painless and may bleed, but it does not protrude from the anal opening.

  • Level two prolapses, or protrudes from the anal opening, when you use the bathroom, but the prolapse retracts on its own.

  • Level three also prolapses. The prolapse retracts only when you use your hand to push the hemorrhoid back into the anus.

  • Level four is a permanently prolapsed hemorrhoid.

Whether internal or external, a hemorrhoid can occur when there is too much pressure put on the area. This often happens when your stool is hard and uncomfortable or you do a lot of straining while passing stool.

As with a fissure, if you have a hemorrhoid, you may notice blood in the toilet or when you wipe. Both internal and external ones can be itchy, but it's usually only the external kind that causes pain. With an external hemorrhoid, you may be able to see or feel the lump.

Learn more about the difference between the two types in the video "Hemorrhoids--3D Medical Animation."

Differentiating Between the Two

The symptoms of a fissure and a hemorrhoid can be similar. Either can cause pain, itching and bleeding. However, if you are in pain and don't feel an external lump, the condition is more likely to be a fissure. If you notice that you are leaking mucus from your anus, the problem is probably a hemorrhoid.

The best way to settle the question of anal fissures vs. hemorrhoids is to see a doctor, who will perform an examination using anoscopy. This involves looking at the area with a special tool.

You might also be referred to a specialist to perform an internal examination. The procedure, called sigmoidoscopy, examines both your rectum and part of your colon with a lighted instrument.

Your symptoms could also be the result of a more serious condition, such as an infection, an abscess or cancer. Before trying to self-treat, have a doctor rule out these other possibilities.

Conservative Treatment Options

Whether you have a hemorrhoid or a fissure, your doctor will probably try conservative treatment options, including at-home care, first. Because the two conditions cause similar discomforts, similar treatments will relieve symptoms.

For example, your doctor might recommend creams. Ointments for fissures reduce muscle spasms. Cortisone creams, such as Cortizone 10, can reduce the swelling of a hemorrhoid. This ointment is also useful for itch relief, but it is only for external use.

To soothe your rear, wipe with Tucks pads instead of toilet paper. These have irritation-reducing ingredients.

A sitz bath provides welcoming relief for anal discomfort. Fill your tub with several inches of warm water and soak your bottom for up to 20 minutes. Repeat this activity throughout the day.

Your doctor will probably recommend that you take care to avoid constipation. You may also be encouraged to take a daily stool softener. This over-the-counter treatment will help keep you from having hard bowel movements. Colace is an example of an effective stool softener.

Surgical Treatment

If conservative treatments are not enough, your doctor may recommend surgical procedures. The goal of surgery for a fissure is to stop the muscles in the area from spasming. This allows the tear to heal. Injections and surgical cuts are two methods used to reduce spasms.

A level one or two hemorrhoid can be treated by cutting off its blood supply. In an outpatient procedure, a colorectal surgeon, general surgeon, gastroenterologist or OB/GYN will use a SapiMed ligator to apply elastic bands to the hemorrhoid. This disrupts blood flow to the hemorrhoid, and it falls off within a few days.

Level three and four hemorrhoids require a more intensive surgical procedure. In a hospital operating room, a specialist will target the veins of the difficult hemorrhoid with a neoLaser. This breaks down the tissue, so the abnormality will shrink.

Preventing Future Problems

Once your anal region has healed, you'll want to be careful so you don't have to go through that discomfort again.

One of the best things you can do is to eat a diet that guards against constipation, such as green vegetables, fiber-rich grains and eight glasses of water every day. To learn more about recommended foods, watch the helpful video "Constipation Diet Tip."

Be careful when you use the bathroom. Don't strain with too much intensity and try not to sit on the toilet for too long. Afterward, wipe gently.

Action Steps

Fissures are tears, and a hemorrhoid is an inflamed blood vessel. No matter which problem you are experiencing, the sooner you seek treatment, the sooner you will find relief. Here's what you should do:

  • Visit your doctor for a diagnosis.

  • Drink plenty of water and eat foods that help bowel movements.

  • Use products like Tucks, Cortizone 10 and Colace to reduce the discomfort of symptoms.

  • Don't strain too hard on the toilet.

  • If the problem persists, ask about surgical treatments.

If you have questions about healing your irritated bottom, be sure to leave a comment below.


Brian Chandler

Brian Chandler