Do I Have Hemorrhoids or Anal Fissure? Ask a Proctologist

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoids.  Fissures.  The Proctologist.

Anal pain is common. Most often, the pain is transient. It comes and then it leaves just as quickly. But what happens when it comes, but doesn’t go? What happens when the pain lingers, intensifies and worsens? A trip to the proctologist (also known as a colon and rectal surgeon, or proctologist) is usually scheduled. Your proctologist is skilled in listening to your history of the pain, examining your anal area in a gentle manner, and then treating you in the most expeditious way possible.

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Is it a hemorrhoid? An Anal fissure? Is it both? To be sure, there are differences between the two. There also similarities. What are the common presenting signs and symptoms of a hemorrhoid?

Hemorrhoid Symptoms:

  • Pain
  • Bleeding
  • Prolapse (protrusion)
  • Itching
  • Discharge (anal moisture)
  • Erythema (redness)

And what about a fissure? What are the presenting signs and symptoms of an anal fissure?

Fissure Symptoms:

  • Pain
  • Pain
  • Pain (yes, it’s that bad!)

Not all hemorrhoids are associated with pain. Most fissures are associated with pain.

Hemorrhoids.  Fissures.  What Are They?

A hemorrhoid is a group of arteries, veins, nerves and connective tissue. Usually, we have 3 groups of hemorrhoids in the anus. The hemorrhoids may swell, enlarge and produce symptoms.

An anal fissure is a cut or tear in the anal lining. Sometimes it is superficial and sometimes it is deep enough to reach the muscles of the anal sphincter. Whether superficial or deep, the underlying anal sphincter has some amount of spasm. This worsens the pain. When patients attempt to clean the anal area with soap, in the misguided belief that anal hygiene will heal anything, the pain intensifies. More soap is applied and the pain increases further.

Treatment?  It Depends On The Diagnosis.

Of course, treatment depends on diagnosis. Hemorrhoid treatment involves some form of topical ointment or hemorrhoidal injections (sclerotherapy), infrared coagulation, rubber band placement or one of the several forms of hemorrhoidectomy, such as PPH (Procedure For Prolapse and Hemorrhoids), or THD (Transanal Hemorrhoidal Dearterialization).

The course of therapy is different in the treatment of an anal fissure. First, the use of anal soap is discontinued…forever. Washing the area with water or gentle, non-soap wipes or not “cleaning” at all should do the trick. The anal area is remarkably self-cleaning and you will not “smell” or leak if you do nothing.

Ointments, Creams and Surgery

Ointments available to apply on the anal area are Diltiazim® 2% applied three times a day (while wearing a glove to avoid absorption through your finger leading to a possible headache or light headedness). This will relax the anal sphincter, allowing the fissure to heal. For superficial fissures, topical 2.5% hydrocortisone ointment may heal the fissure. There are various other medical options, all with a lesser chance of promoting healing. Finally, an operation, a lateral internal sphincterotomy may be required. Your coloproctologist will be able to explain this to you and answer all of your questions. This form of treatment is usually successful.

And, you can have both a fissure and a hemorrhoid. Treatment is directed toward both of these problems.

Los Angeles Colon and Rectal Surgical Associates

In Los Angeles and Beverly Hills, the surgeons of Los Angeles Colon and Rectal Surgical Associates are available to help and to heal. A phone call starts the healing process.  (310)273-2310.  Your appointment is confidential and you will be able to ask the questions you need in order to understand your diagnosis and treatment plan.

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