Anal fissures can be extremely uncomfortable and embarrassing. They typically result from hard or large bowel movements tearing the delicate lining of the anus, although fissures may also occur due to constipation and inflammatory bowel disease.
Symptoms of anal fissures or hemorrhoids may include pain, itching and blood on toilet paper. Your healthcare provider can diagnose anal fissures or hemorrhoids by asking about symptoms and taking a history.
Anal Fissure Vs Hemorrhoids
Difference
Hemorrhoids and anal fissures are two different conditions that can cause discomfort and pain in the anal area. Here are some differences between the two:
Anal Fissures:
- A tear in the lining of the lower rectum (anal canal) that causes pain during bowel movements.
- Usually caused by constipation.
- Short-term (acute) anal fissures usually heal with home treatment after a few days or weeks.
- Can cause pain, burning, and bleeding.
- Can be difficult to differentiate from hemorrhoids because both conditions have similar risk factors and symptoms.
Hemorrhoids:
- Swollen veins in the anal canal.
- Can be internal or external.
- Usually caused by straining during bowel movements.
- Can cause pain, itching, and bleeding.
- Can be treated with sclerotherapy, photocoagulation, and band ligation.
- Symptoms (pain, itching) persist between bowel movements.
While both conditions can cause similar symptoms, one main difference is that anal fissures usually cause symptoms only when passing stool, while hemorrhoids can cause symptoms between bowel movements. It is important to consult a doctor for proper diagnosis and treatment.
Symptoms
When someone complains of difficulty when pooping, an itching sensation in their anal area and blood on toilet paper, they often assume it must be hemorrhoids. But they could instead have anal fissures, an uncommon condition which also exhibits similar symptoms.
Anal fissures form when the tissue of the anus stretches too much during a hard bowel movement. The anus is part of the rectum with a ring-shaped muscle that opens during stool passage to let feces pass. A stretched anal fissure may tear or become inflamed.
An anal fissure typically manifests with symptoms including pain during defecation that increases as more stool passes, larger and bloodier stools than normal passing, an anal fissure being difficult or painful to clean, especially in women, as well as itching sensations – these symptoms may also be relieved with over-the-counter oral pain medications such as acetaminophen or ibuprofen for relief.
To diagnose an anal fissure, your doctor will conduct an interview and physical exam of the area in question. They may use an anoscope, which involves looking directly into the anus and rectum with a lighted instrument.
If the problem persists over time, they may refer you to a colorectal surgeon or gastroenterologist for sigmoidoscopy; an optical tool with a lighted tip will examine parts of both rectum and colon.
Causes
Anal fissures tend to heal on their own if you avoid straining while having bowel movements and avoid constipation, taking stool softeners such as suppositories or medications for softening stool and using warm tub soaks (sitz baths) several times daily can provide temporary relief of both pain and itching, or by switching brands of toilet paper used.
Also using wipes with moisture-reducing ingredients may prove helpful.
Hemorrhoids, on the other hand, are caused by pressure in the anal canal from prolonged sitting or pregnancy, hernias, hernias, inflammatory bowel diseases, anal cancers, rectal surgeries or loss of muscle tone due to age or illness or an anal intercourse.
Common symptoms of hemorrhoids include pain during and after bowel movements as well as itching with occasional signs of blood on toilet paper or bowl.
Your doctor is likely to begin treatment by prescribing conservative measures first for anal fissures or hemorrhoids, such as using ointments that reduce itching and muscle spasms or Tucks pads with ingredients to soothe skin.
Warm baths such as sitz baths may provide added comfort by relieving itching, pain relief and moisturizing an anal area while moisturizing.
Your diet could also benefit from adding fiber-rich meals; alternatively they might suggest medication such as nitrates or calcium blockers or even surgery for release of pressure in anal sphincterectomy.
Diagnosis
Anal fissures typically cause pain during and after having a bowel movement. They can also leave behind bright red blood on toilet paper and result in visible cracks between anus and surrounding skin.
Anal fissures often heal on their own if they are acute (temporary). Your GP can detect an anal fissure by performing a rectal exam; they’ll use either gloved fingers or an instrument called a speculum to check for tenderness and any bleeding; additionally they might recommend performing a stool occult blood test to check for hidden blood sources in stool.
Hemorrhoids are distended blood vessels that form inside or outside your rectum – the portion of your digestive tract connecting your colon (large intestine) with your anus (an organ that connects directly to the anus).
External hemorrhoids appear as swollen veins below your anus skin that may bleed and itch, though they’re generally harmless. Internal hemorrhoids are distended blood vessels in or near your anus that can bleed and itch as well, with some prolapse (when stretched from their original positions within or near anus).
Anal fissures can result from exposure to hard stools or repeated diarrhea, surgery or medical treatments which alter bowel movements or the anus, as well as repeated surgery or medical treatments that interfere with them.
Most anal fissures heal within several weeks with simple remedies like painkillers and taking warm baths; but if they persist longer your GP can prescribe medicine to treat them or, in extreme cases, recommend surgery as treatment option.
Treatment
Even though anal fissures and hemorrhoids may look alike, their treatments differ considerably. Conservative at-home solutions often help resolve anal fissures and hemorrhoids quickly; such as taking sitz baths, relieving constipation or taking stool softeners/fiber supplements. If these methods don’t work, medical advice should be sought from healthcare providers in order to find alternative solutions.
As soon as complications and an anal fissure or hemorrhoid occur, early diagnosis and treatment should begin immediately to avoid further complications and prevent its return.
Your healthcare provider will conduct a physical exam, ordering tests such as digital rectal exam (which involves inserting gloved fingers into your anus) or fecal occult blood tests as needed to make a proper diagnosis of either condition.
If you suffer from anal fissures, your doctor will likely suggest OTC pain relievers such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen). Prescription creams like Diltiazem or Nitroglycerin may also help ease discomfort by relaxing muscles in the anal canal and making bowel movements easier; sometimes these medications can even serve as alternatives to surgery to release pressure on anal canals.
Hemorrhoids can be avoided by limiting consumption of foods that are difficult to digest, drinking plenty of water and exercising regularly, and wiping your bottom gently after going to the bathroom.
