Anal Fissures vs. Hemorrhoids: The Difference & Treatment Options

Anal Fissures: Small Tears

Abnormal bowel movements, such as having very hard stools or diarrhea, can cause a tearing of the sensitive lining of the anus. Anal fissures are what we call these tears. Some risk factors for fissures are diarrhea and constipation, as well as having IBS (which stands for inflammatory bowel disease), being overweight or being of an advanced age.

Anal fissures can cause a lot of pain. When passing stool, they can be particularly painful, sometimes lasting for hours. The pain can sometimes feel like a throbbing sensation.

On occasions, fissures can cause a very strong itch, and you may notice traces of blood while wiping or spots of blood in the toilet.

Hemorrhoids: Swollen Blood Vessels

A hemorrhoid is a swollen blood vessel, which is different from fissures. The swollen vessel becomes very large and can cause discomfort.

Hemorrhoids can be either external or internal. External hemorrhoids, as the name implies, are outside of the opening of the anus. Usually, they look like dark bumps on the skin that sometimes result in bleeding, and many times they can be painful.

The internal kind are classified into four levels, or grades

  • Level one is normally painless and can sometimes bleed, but it does not protrude, or extend, farther than the opening of the anus.
  • Level two hemorrhoids are called prolapses, or protrusions from the opening of the anus. These are evident when using the bathroom, but the prolapse goes back, or retracts, by itself.
  • Level three hemorrhoids are also prolapsed, but to get the prolapse to goes back to its place the only way is to use your hand to push it back into the anus.
  • Level four is reserved for hemorrhoids that are permanently prolapsed and cannot be retracted back into the anus.
Regardless of being external or internal, hemorrhoids can happen when too much pressure is put on that area. Usually, this happens when the stools are hard and cause discomfort, or when you strain a lot while passing the stools. Just like fissures, if you happen to suffer from a hemorrhoid, you may see blood in the toilet or after wiping. Both external and internal ones can cause itching, but it's normally only the external hemorrhoids that cause pain. In case of an external hemorrhoid, you might be able to even see or feel the lump of the protruding blood vessel.

How to Tell the Difference Between the Two

The symptoms of both fissures and hemorrhoids can be somewhat alike. Either of them can cause itching, bleeding and pain. Though if you feel pain but can’t feel an external lump, the problem is more likely a fissure. If you see that you have mucus leaking from your anus, then the problem is likely a hemorrhoid.

The best way to solve the question of hemorrhoids vs anal fissures is to go and see your doctor, who will need to perform a special examination called anoscopy. This procedure involves looking at the anal area with a special tool called an anoscope.

You could also be sent to a specialist and have him perform an internal examination. This procedure, called a sigmoidoscopy, allow the doctor to examine both your rectum and a portion of your colon with a lighted instrument.

Your symptoms may also be due to a more serious problem, like an infection, an abscess or even cancer. Before any self-treatments, make sure to have a doctor rule out any other possibilities.

Conservative Treatment Options


Regardless of whether you have a fissure or a hemorrhoid, your doctor will likely try some options for conservative treatment at first, like at-home care. Since both conditions cause similar discomforts, similar treatments will be able to help relieve symptoms.

For example, your doctor could give you a cream. Some ointments given for treating fissures reduce muscle spasms. Other creams, like Dead Sea Water-based Gel, Nifedipine 0.4%, Lidocaine 5%, can reduce the swelling in case of a hemorrhoid, and in case of an anal fissure, reduces inflammation. This gel is also useful for relieving itchiness.

Your doctor will most likely recommend that you take adequate care to avoid constipation. A daily stool softener can also be one of the suggestions from the physician. This treatment, available over-the-counter, will help prevent you from experiencing hard bowel movements. Normalax is one of these stool softeners.

Surgical Treatment

If conservative treatments aren’t able to manage the symptoms, your physician may recommend a surgical procedure. The purpose of surgery in case of a fissure is to prevent the muscles in the anal area from being able to spasm. This is so the tear can heal. Two different methods commonly used to manage muscle spasms are injections and surgical cuts.

A level one or two hemorrhoid can be managed by stopping its blood supply. Since it’s an outpatient procedure, a variety of surgeons, including colorectal surgeon, general surgeon, gastroenterologist and OB/GYN, will most likely employ a SapiMed ligator to apply some elastic bands to ligate, or tie, the hemorrhoid. This stops the blood flow into the hemorrhoid, and it falls off after a couple of days.

Level three and four hemorrhoids usually need a more invasive procedure. In an operating room inside a Hospital, a medical specialist will locate the veins of the difficult hemorrhoid and will target them with a neoLaser. This neoLaser destroys the tissue, so that the hemorrhoid will shrink in size.

Preventing Future Problems

Once your anal region is completely healed, you will need to be careful so that you don't have to experience that discomfort or have those procedures again.

One of the best recommendations is to eat a diet that helps against constipation, which includes green vegetables, grains rich in fiber and around eight glasses of water a day.

Be careful when using the bathroom. Don't strain too much and try not to sit too long on the toilet. Afterward, wipe gently, to avoid any damage to the anal area.


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