Is It Hemorrhoid Or Anal Fissure?

Medically reviewed by: Gary H. Hoffman, MD
Last modified on January 3rd, 2024

Hemorrhoids and anal fissures are common conditions. And it’s not uncommon for people with hemorrhoids to also develop anal fissures. Plus, both conditions share common symptoms, which might lead to confusion.

So in this article, we will discuss how you can differentiate between hemorrhoids and anal fissures. We’ll discuss what hemorrhoids are, what anal fissures are, how to know whether you have hemorrhoids or anal fissures, and how each condition is treated.

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What are Hemorrhoids?

Hemorrhoids — also called piles — are swollen anal veins that are engorged with blood. Anal veins normally carry blood away from the anus. When the pressure inside the pelvis increases, it blocks the flow of blood in these veins, making them engorged.

Situations where the pressure inside the pelvis increases include obesity, pregnancy, weight lifting, and violent coughing. In addition, unhealthy lifestyle elements like a lack of exercise, not drinking enough water, and prolonged sitting can all lead to hemorrhoids.

Hemorrhoids can be of two types:

  • Internal hemorrhoids: These are found inside the anal canal.
  • External hemorrhoids: These are found outside the anal canal or underneath the skin around the anal orifice.

The most common symptoms of hemorrhoids are bleeding and discomfort when passing stool. However, some people might also experience itching and swelling around the anus.

What are Anal Fissures?

Anal fissures are tiny breaks in the lining of the anal canal, which is called the anal mucosa. The anal mucosa is sensitive and thin, which is why it’s prone to tears when a person passes hard or large stools. Other causes of fissures include constipation (most common cause), long-term diarrhea, child birth, and anal intercourse.

Anal fissures appear differently depending on whether they are acute (recent) or chronic (old):

  • Acute fissures: These are small reddish tears and resemble a paper-cut.
  • Chronic fissures: These are deeper and may involve fleshy growths.

Even though both conditions present with similar symptoms, you can see how anal fissures appear significantly different from hemorrhoids.

The most common symptom of anal fissures is pain that occurs when passing stool, which can persist for hours afterwards. Another important finding is blood-stained stool or blood on the toilet paper.

The tears are usually visible around the anal orifice and are sometimes associated with a skin tag, which is an abnormal outgrowth of skin.

How do I Know if I have Hemorrhoids or Anal Fissures?

It can be difficult to tell anal fissures from hemorrhoids because both conditions have similar risk factors and symptoms. However, one main difference is that anal fissures usually cause symptoms only when passing stool. This is unlike hemorrhoids, where symptoms (pain, itching) persist between bowel movements.

Still, the final diagnosis requires a complete examination by a physician. It’s important to consult a doctor because both conditions have different treatments. Let’s discuss them now.

How are Hemorrhoids Treated?

Small hemorrhoids usually resolve on their own and can be treated at home. In case they persist, procedures like band ligation, sclerotherapy and photocoagulation can be used. If your hemorrhoids are severe and don’t respond to even these treatments, you might need more invasive hemorrhoid surgery.

Band Ligation

In this procedure, your doctor will use a medical grade rubber band and tie it around the base of the hemorrhoid. This constricts the blood vessels that feed the hemorrhoid and cause it to die. The dead hemorrhoid eventually falls off.

The procedure is not painful but you might experience a dull sensation. Fortunately, there is no downtime to band ligation and you can resume your daily activities immediately after the procedure.


This technique uses chemicals (usually phenol) that cause scarring and is usually used for only small hemorrhoids.

Your doctor will use an anoscope to visualize the hemorrhoid and carefully inject it with chemicals. This leads to scarring, which cuts off the blood supply to the hemorrhoid and causes it to shrink.

Patients feel little to no pain during the procedure. However, you may need regular injections at specific intervals to completely shrink the hemorrhoid.


Photocoagulation uses intense beams of infrared light to target the hemorrhoid. This procedure is used for internal hemorrhoids, and creates scar tissue that starves them off their blood supply.

The scarring also holds the hemorrhoid against the anal wall so that it doesn’t pop out of the anal canal in the future.

The downside to photocoagulation is that it can treat only one hemorrhoid per visit. Another downside is that patients are not allowed to lift weights or strain after the procedure, until allowed by their doctor.

How are Anal Fissures Treated?

Some anal fissures may resolve on their own, while others may persist. When treating anal fissures, doctors aim to decrease the pressure and relax the muscles around the walls of the anal canal. This is achieved by softening the stool and easing its movement through the anal canal.

Methods to treat anal fissures include treating constipation, using a sitz bath, being gentle with the anal area, avoiding straining and prolonged sitting, lubricating the anorectal area, topical medications, Botox, and possibly surgery.

Treating Constipation

Constipation is treated with stool softeners and by encouraging patients to drink more water. Eating a fiber-rich diet keeps the intestines healthy and is another good method of treating constipation.

This decreases the impact hard stools have on the sensitive anal mucosa and prevents the tears from worsening.

Sitz Bath

A sitz bath is a simple home remedy for fissures and involves soaking the anal region in warm water. This is done 2-3 times a day for around 15 minutes each time.

Soaking the anal region in warm water relieves pain, relaxes the anal sphincter, and improves blood flow. And this promotes the healing of anal fissures.

Being gentle with the anal region

It is important to make sure that you don’t wipe roughly when you have anal fissures. This can cause pain and worsen your fissures.

Lubricating the anorectal area

Your doctor might advise you to use petroleum jelly to lubricate the anal region. You will find it helpful to do this before each bowel movement. An adequate amount of petroleum jelly should be applied, up to half an inch inside the rectum. This reduces the pain when passing stool.

Topical Medications

These include a variety of medicated creams that promote the healing of fissures. Ointments such as nitroglycerin, calcium channel blockers, and topical muscle relaxants relax the anal sphincter and improve healing.

It is important to note that nitroglycerin and calcium channel blockers can interact with other medicines. So make sure you discuss them with your doctor before use.


Botox contains a bacterial toxin that paralyzes muscles. Injecting botox around the anal orifice decreases anal sphincter muscles, which relieves pain and promotes healing.


Occasionally if a fissure does not respond to office treatments, then surgery may be required to release a tight anal sphincter.  This involves an outpatient surgery under sedation and is extremely effective in resolving symptoms and healing the fissure. As with any surgery, your doctor will discuss the procedure in greater detail.

Now you Know How to Tell Hemorrhoids and Anal Fissures Apart

Hemorrhoids are swollen anal veins that may bulge out or remain inside the anal canal. On the other hand, anal fissures are small tears in the anal lining.

One way to tell the two apart is to note the pattern of your symptoms. Symptoms of hemorrhoids persist between bowel movements. This is unlike anal fissures, where symptoms occur only when passing stool.

It’s also important to note that both conditions have different treatments. Hemorrhoids are treated with sclerotherapy, photocoagulation, and band ligation. This is unlike anal fissures, which are treated with things like ointments, stool softeners, Botox, sitz bath, and lubrication.  Both conditions may be severe enough that may require surgery.

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