Hemorrhoids vs. Anal Fissures: How to Spot the Difference

Hemorrhoids and anal fissures are both anorectal disorders. Though they have some similar causes, they’re two distinct conditions requiring different modes of treatment. 

At Midwest Hemorrhoid Treatment Center in Town and Country, Missouri, our board-certified family medicine physician, Dr. Betsy Clemens, treats both hemorrhoids and anal fissures. 

Many people suffer in silence when they have anal discomfort because they’re too embarrassed to seek help. Hemorrhoids and anal fissures may resolve over time, but you need to know what you’re dealing with so you know how best to treat it. 

Here, we want to explain the differences between hemorrhoids and anal fissures.

What are hemorrhoids?

Hemorrhoids are swollen veins that develop in the lower part of the rectum and anus. Your rectum is the last part of your digestive tract, holding stool before you eliminate it from your body. The tissue in your rectum and anus is stretchy, allowing it to expand and contract as needed. This also causes the blood vessels in the area to expand and widen.

Over time, the blood vessels weaken and can no longer contract with the rectal tissue, leading to enlarged veins. The location of your hemorrhoids determines the type, which includes:

Internal hemorrhoids

Internal hemorrhoids develop in the lower part of the rectum. These hemorrhoids don’t cause pain but may bleed, so you see blood in the stool. They may also protrude — fall outside the rectum, which can cause pain.

External hemorrhoids

External hemorrhoids develop on the outer anal tissue. This tissue is more sensitive, and you’re more likely to feel some anal discomfort or itching. Blood clots may also form in external thrombosed hemorrhoids, causing severe pain. 

It’s theorized that pressure on the anal veins causes hemorrhoids. Chronic constipation, chronic diarrhea, and straining during a bowel movement are contributing factors. 

What are anal fissures?

Anal fissures are tears in the lining of the anal canal, the short tunnel connecting the rectum to the anus. Anal fissures most often develop when there’s trauma to the tissue, such as passing hard, dry stool or having chronic diarrhea.

Anal fissures are painful, causing severe pain during a bowel movement that may last several minutes or hours. This severe, lingering pain is what distinguishes anal fissures from hemorrhoids. 

Your fissure may bleed, causing bright red blood in your stool or toilet bowl. 

Hemorrhoids vs. anal fissures

Hemorrhoids and anal fissures are common conditions that have similar causes and symptoms. Initial treatments for hemorrhoids and anal fissures are also similar and include the following:

• Adding more fiber to your diet
• Drinking more water
• Soaking your bottom in warm sitz baths 

These treatments aim to improve bowel movements and ease symptoms, allowing the hemorrhoids or anal fissure to heal over time. Hemorrhoids may improve within a week or so, but it can take several weeks for an anal fissure to heal. 

Though we can continue with medical interventions for hemorrhoids if your anal fissure fails to heal, you may need surgery to close the tear. 

It’s not uncommon for people to misdiagnose their anal fissures as hemorrhoids, which is why it’s always best to talk with a health professional, so you know exactly what you’re dealing with. It’s vital to schedule a consultation if you have any rectal bleeding. Though hemorrhoids are a common cause, rectal bleeding is also a symptom of colon cancer. 

Do you have anal pain? Are your hemorrhoid treatments not helping? Then it’s time to call us at 636-228-3136 and schedule an appointment today.