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Piles and Fissures – Know the Difference

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Irritable and itchy anal cavity, trouble passing stools, bloody stools, and discomfort when you sit for a long time? – chances are you may have experienced these conditions at some point in time in your life. You’re not alone! 50% of the Indian population suffers from haemorrhoids. It is reported that 20% of cases suffer from piles and fissures together. However, many of us often fail to understand the fundamental difference between piles and fissure since both have similar symptoms.

In this article, Dr Mayank Madan, a leading general surgeon in Gurgaon, explains the difference between piles and fissures

What Is the Difference Between Piles and Fissure?

Piles or haemorrhoids are inflamed veins in the rectal or anal region that may protrude outside, causing discomfort.

An anal fissure, on the other hand, is a small cut on the lining of the anal cavity.

Piles vs Fissure

Here are some essential differences that can help you understand what are piles and fissures.

Piles Fissures
Swollen veins in the anal canal, rectum or anus Tear or cut of anal skin
Painless during the initial phase and increases as the swelling becomes more prominent Very painful and uncomfortable with little or more bleeding
Piles are a result of prolonged constipation, pregnancy or chronic cough, physical strain This occurs during pregnancy, as a result of obesity or an injury to the anal cavity, to people with Crohn’s disease, passing hard stools and chronic diarrhoea

Piles and Fissure Overview

Piles Vs fissures are often misinterpreted due to overlapping signs and symptoms. Here is a detailed overview of piles fissures to help you grasp a better understanding. 

Piles Overview 

Piles can be broadly categorised into three types:

  • Internal Haemorrhoids
  • External Haemorrhoids
  • Thrombosed Haemorrhoids

The symptoms and treatment options purely depend on the kind of haemorrhoid you have and its severity. When deduced in the initial stages, you can even treat it with simple lifestyle changes and natural home remedies.

1. Internal Haemorrhoids

Internal haemorrhoids occur as hard lumps in the back passage inside the rectal cavity. You might not feel them initially as that region has very few pain-sensing nerves. However, in case you have prolonged constipation or strained bowel movement, then this can cause occasional bleeding and pain.

Internal haemorrhoids can be further classified based on their severity:

  • First-degree haemorrhoids stay in the rectum. They may bleed but generally don’t cause much discomfort.
  • Second-degree haemorrhoids are a bit more swollen and prolapse when strained, usually during defecation. They return to the rectum on their own after some time.
  • Third-degree haemorrhoids don’t relapse on their own and need to be pushed in. These are a bit painful and take time to heal.
  • Fourth-degree haemorrhoids always remain outside the rectum and cannot be pushed back inside.

Some of the standard inner piles’ symptoms include:

  • itching in the anal region
  • irritation and pain in the anus
  • leakage of stool
  • lump or swelling inside the anal cavity
  • occasional bloody stools due to rupture

2. External Haemorrhoids

External haemorrhoids are more prominent and painful as they occur in the outer region of your anal canal. They usually are covered with regular skin and have pain nerves surrounding them. This variant of piles is more painful and has a high risk of clots, skin tags, and other related skin infections.

3. Thrombosed Haemorrhoids

Thrombosed haemorrhoids are characterised by a blood clot that prevents blood flow. Sometimes these haemorrhoids burst and start bleeding due to excessive blood. If you are wondering if these are bleeding haemorrhoids are dangerous, worry not! Although thrombosed haemorrhoids can cause a lot of pain and discomfort, they are usually benign.

Fissures Overview

Unlike piles, anal fissures can be very painful right from the beginning. The light tear on the moist tissue of the anal region can cause painful itching and spams in the anal sphincter.

Depending on the severity of the condition, fissures can be categorised as:

1. Acute Fissures

Acute fissures are freshly developed and thus, can be treated easily. One can encourage the self-healing of these fissures with simple home remedies.

If left untreated, however, they can manifest as chronic fissures in the future.

2. Chronic Fissures

These are fissures that last for more than 8-12 weeks and need medical assistance to heal.

Along with the anal tear, chronic fissures also involve a swelling commonly known as a skin tag, and extra tissue growth known as hypertrophied papilla.

3. Fissure Symptoms

Usually, anal fissures entail a searing pain at the bottom. However, other fissure symptoms that you may experience are:

  • Occasional bleeding especially while defecating
  • Tightening of the anus accompanied by a sharp spasm
  • Painful boils which may be filled with pus
  • Mucus-like smelly discharge

Best Treatment for Piles and Fissure

A typical fissure or haemorrhoid is easy to manage and would take a minimum of 6-8 weeks to heal completely.

You can try the following methods for the best treatment for piles and fissure for faster healing:

  • Increasing your fibre and fluid intake can make the stools bulkier and soft. This would make it easier to pass through without causing any pain.
  • A cold compress and ice packs can help eliminate pain and is the best treatment for piles and fissure.
  • A sitz bath, which is a warm bath with salts, is a commonly prescribed and efficient home remedy for piles and fissure.
  • Wearing loose cotton clothing that doesn’t rupture the affected region further can alleviate the pain.
  • Drinking 500-600 ml of water on an empty stomach helps to activate the gastrocolic reflex (a contraction of your colon to release stools).
  • If the conditions persist for more than a week, it is best to get a medical consult.

Depending on the severity of the condition, your medical practitioner might prescribe stool softeners, over-the-counter creams and topical ointments.

One can treat these health issues without operations, but in severe cases, your doctor may suggest surgery of piles and fissure. Depending on your condition, you can also opt for advanced methods including laser treatment for piles and fissure

What to Avoid in Piles and Fissure?

Certainly, you would know the difference between fissure vs piles. However, their symptoms can be managed by slightly altering your lifestyle. 

Here are some recommendations you should follow if you are suffering from piles and fissure:

  • Avoid spicy food 
  • Avoid fried food 
  • Restrict the consumption of caffeinated beverages 
  • Avoid drinking alcohol 

Prevention of Piles and Fissures

You can prevent the onset of piles fissures with good lifestyle choices. The preventive measures for these conditions entail promoting healthy bowel movement.

  • Eating high-fibre foods
  • Drinking a lot of water
  • Following a daily exercise regime – practice yoga for piles and fissure prevention 
  • Avoiding long hours on the toilet

The Concluding Note

For many people, discussing anorectal disorders can be embarrassing and acts as a barrier to getting the right care. But these issues are liable to worsen if not addressed immediately. To seek the right care, it is essential to stay informed about your condition. Thereby, one should know the primary difference between piles and fissure. To avoid further health complications, one must seek medical advice as early as possible.

To get the best laser treatment for piles and fissures, visit CK Birla Hospital or book an appointment with Dr Mayank Madan, a leading general surgeon in Gurgaon


Ques: What is the primary difference between piles and fissures?

Ans: Piles are swollen blood vessels while fissures are cuts, tears or cracks of the anal skin. 

Ques: How to get rid of piles permanently?

Ans: To get rid of piles permanently, you should eat high-fibre foods, more fruits, vegetables and whole grains. 

Ques: Can piles and fissures occur together?

Ans: Piles and fissures can happen together or separately. 

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