Categories: Urology

Difference between Piles, Fissures and Fistula

The common thing about these disorders is that they all are anal pathologies. The anus is the last orifice from which the stool is excreted. It is 4-5cm long. A terminal part of the anus has sensitive nerve endings, lined by blood vessels. The middle portion possesses several anal glands. Once we are through with the anatomy of the anus, let’s look into its various disorders.

Let’s look at each of the anal disorders: 


What is piles disease?

Also called hemorrhoids, anal piles are swollen veins in the terminal part of the anus.

Some quick facts: 

  • They may affect 75% of the population by age 50.
  • Common in pregnancy.
  • They can be internal or external.
  • Presenting symptoms may be bleeding after passing stool or bloody stool.
  • Sometimes blood can clot surrounding anus causing external hemorrhoids.
  • Mostly they cure by themselves even before symptoms begin to appear.
  • Caused due to chronic constipation, difficult bowel movements.

Is piles dangerous? 

Generally, piles are not that serious. They normally get okay in a few days. Some of the common symptoms of piles are: 

  • Painful lump around the anus
  • A feeling of full bowels even after passing stool
  • Bright red blood after bowel movements
  • Itchy, red, and sore anus
  • Pain during the passing of stool

Piles become serious when there’s

  • Anal bleeding leading to anemia
  • Fecal incontinence
  • Anal fistula
  • Strangulated hemorrhoid leading to a blood clot or infection

Causes of piles

Piles generally occur due to excessive pressure in the lower rectum. Some of the reasons for piles:

  • Chronic constipation
  • Chronic diarrhea
  • Lifting heavyweights
  • Pregnancy
  • Straining while passing stool

Is piles curable? 

In most cases, piles go away on their own. In case they don’t, you can try out some treatments such as: 

  • Lifestyle alterations such as dietary changes or trying to reduce body weight
  • Medications such as laxatives and corticosteroids
  • Surgical treatments such as banding, sclerotherapy, infrared coagulation, and hemorrhoidectomy, and hemorrhoid stapling


What are fissures?

They are identified as a tear around the anus and is very painful.

  • Happens at times when a person stretches and pressurizes too much to defecate.
  • They may ooze blood or pus if infected.
  • They may occur due to constipation, diarrhea, and heavy exercising.
  • They mostly affect age groups above 50.
  • They may present in acute and chronic forms.
  • An acute fissure can be easily cured with a fiber-rich diet and medication.
  • Chronic is difficult to manage and can recur.

How to know if you have anal fissures? 

Some of the signs and symptoms of anal fissures are: 

  • Severe pain during bowel movements
  • Lasting pain after bowel movements for several hours
  • Bright red blood after bowel movements
  • Lump or skin tag near anal fissure

What can cause anal fissures?

Some of the common causes of anal fissures are: 

  • Passing large or hard stools
  • Straining during bowel movements
  • Chronic diarrhea
  • Anal intercourse
  • Childbirth

Some other less common reasons for anal fissures are: 

  • Crohn’s disease
  • HIV
  • Anal cancer
  • Tuberculosis
  • Syphilis

Are there any complications for anal fissures? 

In case the anal fissures become serious, they may lead to complications such as: 

  • They may fail to heal. If it crosses eight weeks, then they may require more treatment.
  • They may recur and you may have more than one.
  • They may extend to the surrounding muscles, making it difficult to heal.


What are fistulas? 

The anal glands in the middle portion of the anus may get infected and cause an anal abscess, which starts oozing pus. Fistulas are the passage connecting the infected gland to the abscess.

Some quick facts

  • They may be caused due to radiation, cancer, warts, trauma, Crohn’s disease, etc.
  • They may also be associated with obesity and prolonged hours of sitting.
  • They are presented as an opening oozing pus, swollen, painful, and red.
  • They can be treated with antibiotics.

What are anal fistulas caused by? 

Anal fistulas occur when the fluid glands in your anus are blocked. This leads to a bacteria buildup that may create pockets abscesses.  Unless treated, abscesses may grow, finally moving outside near the anus hole to drain out. In most cases, abscesses may turn into fistulas. They may also be a result of conditions such as tuberculosis and sexually transmitted diseases. 

How to identify anal fistulas? 

When you have anal fistulas, you may experience signs such as pain, redness, and swelling around the anus. There can also be bleeding, painful bowel movements, and fever. In such cases, it’s advisable to visit a doctor. 

Is it possible to diagnose anal fistulas? 

Your doctor may be able to diagnose your anal fistula after a physical exam. Some fistulas may be easy to diagnose, some may not. Your doctor may check for oozing fluids or bleeding. They may also refer you to specialists in the colon and rectal problems. You may have to conduct some other tests such as X-rays or CT scans. 

How are they all different?

  1. Piles are mainly the swollen blood vessels while fissures are kind of cracks and fistulas are an opening of a cavity.
  2. Piles are mostly painless and unnoticeable. Fissures cause a lot of pain. In the case of fistulas, pus is discharged out of the anal area.
  3. Apart from constipation, which is commonly associated with all three, piles are also associated with pregnancy and a constant cough. Fissures are associated with diarrhea and pressurizing to defecate. Fistulas may commonly be a result of Crohn’s disease, obesity, and sitting in one place for prolonged hours.
  4. All three can be prevented by a high fiber diet and more intake of fluid. In addition, fistula can be prevented by practicing better hygiene practices involving defecation.
  5. Piles are easily treated by over the counter medication and home remedies. But to treat fissures, medication and surgical procedures like lateral sphincterotomy may be required. Detection and treatment of fistula are all the more difficult and may require MRI or sonofistulagram to spot the passage of occurrence. They are treated through a procedure called video-assisted anal fistula treatment and other similar approaches.

Rectal bleeding in itself is a noticeable symptom and medical advice should be taken about it. All the above conditions have excellent outcomes once taken care of personally and medically. Ignoring the condition might lead to unexpected complications. As common as they are, a lot of people are facing similar problems as you are. It’s yet another disorder and it’s considered as one, don’t be embarrassed to ask for help, it’s just around the corner!

Dr. Amit Goel, Consultant – UrologyDharamshila Narayana Speciality Hospital, Delhi

Narayana Health

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