Anal Fissure vs. Hemorrhoids: What Are the Differences?

An anal fissure and a hemorrhoid are different conditions. An anal fissure is when there is a tear or a crack in the anus. A hemorrhoid is when a vein in the anus becomes swollen. Both conditions can cause pain and bleeding. However, because they’re treated differently, it’s important to be able to tell them apart.

Learn more about the differences between an anal fissure and a hemorrhoid, including how they are diagnosed and treated.

Symptoms

Some symptoms in common of an anal fissure and a hemorrhoid include blood on or in the stool and pain while having a bowel movement. However, they can cause other problems as well. Telling the difference between them based on symptoms might be difficult, so a diagnosis from a healthcare provider is needed.

The symptoms of an anal fissure can include:

• Bleeding from the rectum
• Pain while having a bowel movement
• Pain that lasts for hours after a bowel movement
• Discomfort or tenderness in the anal area
  

The symptoms of hemorrhoids can include:

• Bleeding from the rectum
• Feeling like there is an object in the anus
• Itching in or around the anus
• Pain in or around the anus
• Pain while having a bowel movement
• Rectal pain
  

Causes

When the anus is damaged, it can lead to the development of a fissure. Some of the potential causes of a fissure include:

• Constipation: Having hard stools that are difficult to pass
• Diarrhea: Having loose stools, sometimes multiple times a day
• Sexually transmitted infections (STIs): Infections that spread from person to person through sexual contact
• Inflammatory bowel disease (IBD): Chronic conditions that cause inflammation in the intestines, including Crohn’s disease and ulcerative colitis
• Human immunodeficiency virus (HIV): A virus that affects the body’s immune system 
• Childbirth
• Other trauma
• Tuberculosis: An infection with the bacteria Mycobacterium tuberculosis
  

Hemorrhoids have some causes in common with fissures, but there are also other reasons that a hemorrhoid can develop. Some of the potential causes of a hemorrhoid can include:

• Constipation
• Diarrhea
• Heavy lifting, which can include straining to pick up something
• Pregnancy, which can lead to strain on the muscles in the pelvic floor
  

Diagnosis

Diagnosing an anal fissure or a hemorrhoid may be done in a few different ways. 

First, a healthcare provider will take a medical history. They will ask about pain, bleeding, itching, or burning, as well as other signs and symptoms such as constipation or diarrhea. It may help to keep a record of these symptoms in the days or weeks leading up to an appointment with a healthcare provider.

A physical exam is usually also done. The healthcare provider will want to take a look at the anal area.

They may do a digital rectal exam. This is when a gloved, lubricated finger is quickly inserted into the anus. A healthcare provider can feel if there are any internal hemorrhoids. Also, if the glove comes away with blood or other fluid on it, that can help with the diagnosis.

An anoscopy or proctoscopy is another test that might be done. This is when a thin tool with a light on the end is used to look inside the anus and rectum. A biopsy, which is a small piece of the tissue from the area, might also be taken and analyzed in the lab.

Before a physical exam or another test, you may want to ask about pain relief. Over-the-counter (OTC) oral pain relievers such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) may help. There may also be local anesthetics that can be used on the area to lessen the discomfort during an exam.

Treatment

There are some treatments that will be used for both an anal fissure and a hemorrhoid. However, others will work for one but not the other, so getting a diagnosis and understanding which condition is present is important.

Fissure

A fissure might be treated through home remedies, lifestyle changes, OTC and prescription medications, and surgery.

At home, you can try a sitz bath (sitting in warm water), eating more fiber, drinking more water, and using a bidet after a bowel movement instead of wiping. Fiber supplements and stool softeners might also be used, but they should be started after getting a recommendation from a healthcare provider.

Prescription medications can include nitroglycerin or pain relieving creams applied directly to the anus. Oral medications can include calcium channel blockers, which might be used after topical treatments haven’t provided relief. 

For fissures that become long-term and aren’t getting better with lifestyle changes, home remedies, or even medications, surgery might be the next step. A lateral internal sphincterotomy is the most common surgery done. It reduces tension on the inner anal sphincter muscle, allowing more blood flow and better healing.

Other options include a fissurectomy (removing damaged skin from around the fissure) or anal advancement flap surgery (a flap of tissue is used to cover the fissure area).

Hemorrhoids

Hemorrhoids are most often treated with home remedies and by alleviating anything that might be causing them, such as constipation or diarrhea. Prescription medications and surgery might be done for more serious hemorrhoids that aren’t improving.

To alleviate pain and other symptoms, witch hazel pads (such as Tucks), barrier creams (such as those that contain zinc oxide), or creams containing phenylephrine (such as Preparation H) might be used at home.

Most hemorrhoids improve with conservative treatments that can be used at home. However, some do not improve, or they become complicated.

Procedures to reduce the size or remove the hemorrhoid might then be used. These can include rubber band ligation (a rubber band is placed around the base of the hemorrhoid), sclerotherapy (a solution is injected into the hemorrhoid to shrink it), infrared photocoagulation (a light creates heat to shrink the hemorrhoid), or electrocoagulation (a tool with an electric current is used to shrink the hemorrhoid). 

Surgery might also be used for hemorrhoids that don’t respond to other treatments. Removal of a hemorrhoid is called a hemorrhoidectomy, which will be done while the person is sleeping under general anesthesia.

A stapled hemorrhoidopexy is another surgery where prolapsed hemorrhoids (those that protrude from the anus) are stapled in place.

Prevention

Prevention methods for a fissure or a hemorrhoid are similar in many ways, but there are a few differences.

Fissure

Preventing a fissure includes ensuring that stools are neither too hard (constipation) nor too soft or loose (diarrhea) and are easily passed. In addition, getting enough fiber in the diet and drinking enough water is important for having regular bowel movements. Straining to pass a bowel movement is also to be avoided. 

Hemorrhoids

Preventing constipation, diarrhea, and straining on the toilet is also important to preventing hemorrhoids. Sitting too long on the toilet can be a risk factor for hemorrhoids, so that should be avoided.

Lifting heavy objects or weight lifting can contribute to the formation of hemorrhoids. Learning to lift heavy objects properly is important so as not to strain. For those prone to hemorrhoids, check with a healthcare provider about any restrictions..

Summary

While there are many similarities in the causes, treatment, and prevention of an anal fissure and a hemorrhoid, there are some clear differences. Both may show blood in the stool and rectal pain. Both can be caused by constipation or diarrhea. An anal fissure may also be caused by trauma, infection, or inflammatory bowel disease.

Getting a diagnosis and a treatment plan from a healthcare provider is important in healing and preventing complications.

Conservative at-home treatment can usually resolve either problem, such as using a sitz bath and relieving constipation or diarrhea. Each condition has procedures or surgical techniques that can be used in cases that do not resolve with at-home treatment.

A Word From Verywell

Fissures and hemorrhoids can be distressing and embarrassing problems to deal with. Talking about bathroom problems in the anal area with a healthcare provider can be difficult. Still, it’s important to remember that they won’t be shocked or surprised.

Getting a diagnosis and the right treatment is important to feeling better and not having the problem worsen or come back.