Difference between piles, fissures, and fistula


Last Updated February 22nd, 2023

Piles, fissure, and fistula – introduction

Piles, fissure, and fistula are three diseases categorized under the broader topic of proctology and exhibit related symptoms. They are also by far the most common anal problems encountered in the population. Despite sharing certain symptoms, the three diseases are different, implying that the methods of treatment are also different. In this article, we tell you the difference in the causes, risk factors, symptoms, and treatments for each of these three disorders.

Piles, fissures, and fistula – basic difference

Piles, fistula and fissures are often misunderstood as constituting the same anal disorders. Nonetheless, the two anal conditions differ with regard to their definitions. An anal infection happens after the tunnel between the anus and the surrounding skin gets infected. The infection results in the accumulation of pus. Simply put, an anal fissure is a form of anal opening with an abscess. In contrast, an anal fissure refers to a small tear or cut on the thin membrane or lining that surrounds your anus. You are likely to experience an inflammation of the affected region, along with severe pain. Some people may also bleed after having a bowel movement.

On the other hand, anal piles (also commonly referred to as hemorrhoids) happen after the veins that supply blood to your lower rectum and anus get inflamed.  Anal piles can be internal, meaning that the problem occurs inside the rectum. This is different from the external anal piles where the problem develops around your anus. Piles may also be characterized by the formation of painful clots adjacent to your anus.

Having identified the basic difference between these three anal disorders, we will now proceed to explore each of them in detail. This article provides you with all that you need to know about anal fissures, fistula, and piles, starting with their causes, symptoms, and treatment.

What are the symptoms of anal piles?

  • Anal lump :Anal piles or hemorrhoids manifest in a lump around your anus.  Anal piles are hard. Some piles contain blood as well and can be either internal or external.  You are likely to experience severe pain while having a bowel movement, as a result of this lump.
  • Pain while having a bowel movement: You are more likely to feel discomfort or pain while passing stools. This could be an indication of anal piles. Pain is present in both internal and external piles
  • Blood in stool: If you observe carefully, you are likely to notice the presence of bright red blood while having a bowel movement. This should happen often, as opposed to once. It could be an indication of something else. For example, you may have eaten a spicy meal. On the other hand, in case bleeding goes on for two or more days, it could be a sign that you have anal piles
  • Feeling the urge to pass stool even after a bowel movement: In case you feel like defecating even after having used the bathroom, this could also be another symptom of piles
  • Slimy mucus: You may discharge slimy mucous from your anus after having a bowel movement. This acts as a leading sign of piles

What causes piles?

Several risk factors are implicated in the development of anal piles. Some of the leading causes of anal piles include:

  • Chronic Constipation
  • Sitting for long duration of time
  • Persistent diarrhea
  • The pressure caused on your rectum and anal regions by a fetus in pregnant women
  • Anal intercourse
  • Consuming a diet that is deficient in dietary fiber
  • Pressure exerted on your anal region while lifting heavy objects

How can we treat anal piles?

In treating piles, your healthcare provider will be interested in the stage of your piles. If you have presented with first-stage piles, your healthcare provider will mostly recommend lifestyle and dietary modifications to correct the condition. In case the anal piles is at an advanced stage, your surgeon might recommend medication or surgical procedure. It is important that you consult with your physicians as soon as any of the symptoms of anal piles become apparent. This will allow your doctor to determine the stage at which the piles are at and hence make effective recommendations for treatment. This will also limit the likely complications that could accompany piles at an advanced stage.

There are certain things that you can do at a personal level to avoid the pain caused by anal piles. For example, eating a diet rich in dietary fiber. Examples of such foods include legumes and various types of fruits and vegetables. Increased physical exercise also helps, as this allows you to lose weight. You can also avoid lifting heavy objects. In terms of medication to treat piles, your doctor may recommend laxatives and painkillers.

If these fail to treat piles, the only other option left is undergoing a surgical procedure. Examples of common surgical procedures include banding, hemorrhoid stapling, and sclerotherapy. New techniques have also emerged in recent years. Laser hemorrhoidectomy remains by far the most preferred surgical procedure. This is because it is less invasive, has a near-zero recurrence rate, and is less invasive.

What are the symptoms of anal fissure?

Anal fissures are a common problem in adults and are a source of discomfort. Anal fissures also disrupt daily activities and general wellbeing. The following symptoms may be useful in terms of helping you know if you are suffering from an anal fissure:

  • Presence of a skin lump or tag: Anal fissures manifest as a lump of skin adjacent to your anus
  • Sharp pain: If you experience excruciating pain while passing stools, this can be a useful indicator that you have anal fissures.
  • Burning sensation or itching: One of the prominent symptoms of anal fissures is the feeling of a persistent burning sensation around your anus. The affected region may also feel itchy
  • Blood spots: The presence of blood spots on your tissue paper or in the stool could be yet another key symptom of anal fissures 

What are the likely causes of anal fissures?

Anal fissures can be a result of several risk factors as follows:

  • Tight anal sphincter muscle: If your anal sphincter muscles are very tight, this will undoubtedly increase pressure around your anal canal. Consequently, the anus is highly prone to tearing
  • Inflammatory bowel disease: Certain IBDs such as Crohn’s disease predisposes you to the development of anal fissures
  • Pregnancy: Pregnant women are highly susceptible to anal fissures. This is because the fetus exerts pressure around the anal region, and this can cause tearing
  • Anal intercourse: Penetration of the anus tends to overstretch the surrounding skin. This can in turn, cause tearing
  • Age: While all of us are susceptible to anal fissure, they are more prevalent in middle-aged adults and infants

How are anal fissures treated?

For some people, home remedies are sufficient in the treatment of anal fissures. This is because, for such people, the risk of complication is remote. However, it is important that you consult your doctor for a thorough examination. This will determine the nature of your anal piles and hence act as a useful guide in proposing the most appropriate form of treatment. If the fissure is not dangerous, your doctors will most likely prescribe a diet and lifestyle modification. At times, it may be necessary to prescribe injections or ointment to reduce the pain. Should these prescriptions fail, your surgeon can advise a surgical procedure. One such surgery that is quite common is lateral internal sphincterotomy (LIS). This kind of surgery is simple and fast, and the pain is minimal.

Due to advances in science and technology, it is now possible to get treated for piles using laser surgery. The procedure entails the use of a CO2 laser. The laser emits infrared radiations that, in turn, improves the flow of blood to the anal region where the fissure is located. Consequently, CO2 laser assists in the proper healing of your anal fissure.

What causes an anal fistula?

Anal fistulas develop due to the blockage of glands that supply fluids to organs and body parts near the anal region. This is followed by the growth of bacteria, as there is no moisture, thus resulting in the development of pockets, or abscesses. It is important to treat these abscesses as soon as possible. Otherwise, there is a likelihood of them growing out and protruding near the anal opening as they find a way to drain. Such abscesses could transform into an anal fistula. Other conditions like sexually transmitted diseases (including Herpes and AIDS) might cause fistulas, while tuberculosis is also a risk factor. Other conditions that are associated with fistulas include obesity, prolonged sitting, and colon infection.

What are the possible signs and symptoms of anal fistula?

  • Severe pain: Just like in the case of anal fissure and piles, anal fistulas also cause excruciating pain while passing stool
  • Inflammation and swelling around your anal region: fistulas are linked to inflammation and redness near the anus
  • Fever: Unlike fissures and piles, anal fistula can lead to fever
  • Pus discharge: The fistula leads to the discharge of pus, as it tries to drain. This makes you feel wet around your anal region
  • Difficulty in passing stool
anal disorders

How do we treat anal fistula?

To treat anal fistulas, your doctor will most likely prescribe antibiotics. This helps to minimize infection in your anal region. However, for certain patients, it may be necessary to undergo a surgical procedure, especially if the fistula is at an advanced stage. In this case, surgery helps to eradicate fistulas fully. One such surgical procedure is known as fistulotomy. The procedure entails cutting open the fistula in its entirety, promoting healing of the scar.

Your doctor may also recommend a seton procedure. It entails placing a special thread known as seton in the fistula. The thread is left in place for several weeks. This aids in the healing of the fistula while also paving way for another procedure to correct the condition.

Courtesy the advances in science and technology, patients with anal fistula can now benefit from laser surgery for the treatment of anal fistula. The procedure relies on the use of laser energy. It is fast, painless, and highly effective, with no recurrence

Piles , fissures and fistula

Piles, fissures, and fistula can be a painful experience, plus most people are embarrassed while discussing these ailments. Anal fistula, piles, and fissures are among the main types of anal disorders. The three anal disorders share in common similar symptoms, including bleeding, constipation, and pain while having a bowel movement. While all three conditions affect the anal canal, each of these anal problems is characterized by differing intensities, while they also occur at varying sub-locations.  It is important to consult a specialist the moment you experience any of these symptoms. This will allow the doctor to make a proper and timely diagnosis. It will also avoid the complications that is likely to accompany either of these conditions.

goficure is a storehouse of specialists and hospitals that can assist you with surgery and treatment for piles, fissures, and fistula. Our team is already facilitating the services for a number of patients and we are well-versed with the process from start to completion.

When patients trust their medical care with us, they receive a total healthcare solution right from diagnosis to recovery

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  • Regulating post-operative care, which includes post-op consultation, monitoring prescription medication, and enabling diet plans after consultation with nutritionist at Bangalore
  • Complete care until patient is back to normal


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