Tell Me About

Published: Wednesday December 12, 2012 MYT 12:00:00 AM
Updated: Wednesday August 14, 2013 MYT 11:44:44 AM

Difference between anal fissures and haemorrhoids

Learn the difference between anal fissures and haemorrhoids.

I WAS in England recently and I had constipation because of the cold weather. This caused me to strain in the toilet. Suddenly, and very alarmingly, I felt something pop out. I believe it was a pile. I came home and went to a surgeon who told me I not only had piles, but also anal fissures. What is the difference?

Piles are also called haemorrhoids. They are masses or pieces of tissue inside your anal canal that contain blood vessels. The surrounding tissue is made up of supportive tissue, muscles and fibres.

If you are unsure about what constitutes your anal canal, it starts from the anus, which is the hole or opening outside that is present between your buttocks, and extends up to four centimetres all the way to the rectum.

Haemorrhoids are present in every single person. It’s only when they are enlarged that they are considered abnormal.

An anal fissure is, as its name suggests, a tear occurring in your anus that can extend up to your anal canal. They are very common, and can happen at all ages, including in infants.

My goodness, this sounds painful. How will I know if I have anal fissures?

People with anal fissures experience pain, which becomes worse with bowel movement. You don’t experience pain all the time, but certainly, when you sit on the toilet to pass motion, there will be pain, ranging from mild discomfort to severe pain, especially when your stools are hard.

This pain may be brief, or it can last for a long time after your bowel movement. Some people who experience severe pain are almost afraid to go to the toilet.

Sometimes, this pain can also affect your urination by causing frequent urination, pain during urination, or even the inability to urinate.

Anal fissures can also cause bleeding in small amounts and anal itching. If infected, there can be a smelly discharge of pus.

Anal fissures can be divided into acute fissures and chronic fissures.

An acute fissure will look like a longitudinal tear to the surgeon. A chronic fissure is usually associated with skin tags at the edge of your anus, which are called sentinel piles, and thickened edges at the fissure.

How is this different from piles?

Haemorrhoids are divided into internal and external haemorrhoids. Internal haemorrhoids are usually painless because the nerve fibres that supply them belong to the nerve supply of the intestine, which cannot be felt.

An enlarged internal haemorrhoid may pull down the surrounding tissue and protrude from the anus.

Haemorrhoids can bleed, especially when hard stools injure the lining of the anal canal. Sometimes, they can also prolapse, meaning they protrude from your anus.

There is a grading system for haemorrhoids:

First degree: These bleed, but do not prolapse. Second degree: These prolapse, usually after defecation, but retract on their own back into the anal canal. Third degree: These prolapse, but cannot retract on their own. They must be pushed back with a finger, but will stay inside after being pushed back. Fourth degree: These prolapse and cannot be pushed back inside.

Second degree: These prolapse, usually after defecation, but retract on their own back into the anal canal.

Third degree: These prolapse, but cannot retract on their own. They must be pushed back with a finger, but will stay inside after being pushed back.

External haemorrhoids are different though. They can be felt as bulges at your anus. They are easily prey to blood clots, which can make them very painful. Sometimes, they may heal and leave a tag of skin protruding from the anus.

What causes anal fissures?

They are caused by any sort of injury to the anus or anal canal. This usually comes from constipation, which gives rise to hard stools. Many people can remember the exact bowel movement that triggered the pain.

However, diarrhoea can also give rise to anal fissures, especially after repeated episodes.

Sometimes, the injury comes from the insertion of an instrument, like a thermometer, proctoscope, colonoscope or ultrasound probe, to examine the prostate. Needless to say, if you have anal sex, this can also be a cause.

Sometimes, a tear can also come after childbirth. Most anal fissures that result from injury occur in the midline, either in the front or the back (facing the spine).

Fissures that occur in any other position should be investigated for an underlying sinister cause like infections, tuberculosis, or even, anal cancer.

How do I get my anal fissures treated?

The majority of acute anal fissures heal. But chronic fissures don’t heal that easily.

Treatment includes adding ‘bulk’ and ‘fibre’ to the stools. You should increase your liquid intake, avoid ‘sharp’ foods like popcorn, nuts etc, or take stool softeners.

You can take sitz baths after defecation as they are very relaxing and cleansing.

You may be given anaesthetic creams or steroids by the doctor to apply before defecation. If all else fails, you can opt for a simple surgery.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. For further information, e-mail The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Tags / Keywords: Health, Lifestyle, Health, Health, Tell Me About, column, anal fissures, haemorrhoids

More Articles

Filter by

Passengers of an Airbus A380-800 airctaft of Emirates Airline disembark after landing at Tehrans IKA airport on September 30, 2014. Dubais Emirates Airline made a one-off flight to the Iranian capital, for the first time with its flagship Airbus A380 plane to celebrate its recent introduction of more flights on the route. AFP PHOTO/BEHROUZ MEHRI

Deep vein thrombosis: A bad clot

30 October 2014

Beware blood clots in the deep veins of the body.

Hidden danger: You can get hepatitis A not just from eating contaminated cockles, but also from contaminated food or water. - Filepic

What are hepatitis A, B, C, D, E and G?

3 July 2014

My brother’s eyes turned yellow and he had mild fever. The doctor told us he had hepatitis. I'm told this is quite common in our country.

epa03192046 A Kashmiri Muslim potter leaves his footprint in the mud as he works on an earthen pots in the outskirts of Srinagar, India, 22 April 2012. Earth Day is marked annually on 22 April, to raise awareness and public responsibility in environment-sustainable practices to care for the earth.  EPA/FAROOQ KHAN

Why do I have flat feet?

24 April 2014

A person with flat feet or fallen arches has low arches or no arches at all.

My mother has Alzheimer’s

10 April 2014

It’s a disease that progressively ‘steals’ the identity of it’s sufferer. What’s left is a shell that used to be your loved one.

I don't know what a psychometric questionnaire is

27 March 2014

The Myers-Brigg Type Indicator (MBTI) assessment is a psychometric questionnaire that you can fill in to give an indication of your psychological preference and how you perceive the world.

Seeing clearly through surgery

6 March 2014

Surgical methods to improve eyesight.

My neighbour's kid has Down Syndrome

13 February 2014

Down syndrome or Trisomy 21 is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21.

My uncle has prostate cancer

29 January 2014

One of the most common cancers in men is prostate cancer.

What's this lump in my breast?

16 January 2014

The many causes, benign and otherwise, of breast lumps.

What colour is your urine?

1 January 2014

There are many reasons for cloudy and discoloured urine.


Recent Posts