The Key Difference Between Piles and Fissures

If you’re looking for information on piles and fissures, you’ve come to the right place. Piles (also known as haemorrhoids) and anal fissures are two common conditions affecting the anal region. They often present with similar symptoms, such as rectal pain, discomfort, and bleeding, which can lead to confusion. However, they differ significantly in terms of their underlying causes, specific clinical presentation, and treatment approaches [1].

Both conditions can often be managed through lifestyle changes, like increasing dietary fibre and fluid intake, though more severe cases may require medication or surgical intervention. It is essential to consult a healthcare professional if you are experiencing symptoms to get an accurate diagnosis and determine the appropriate course of treatment. This article will discuss the key differences between piles and fissures, enabling you to understand these conditions better.

What are Piles (Haemorrhoids)?

Piles, also known as haemorrhoids, are a condition where the veins in the rectum and anus become swollen and inflamed [2]. They are common and often caused by increased pressure in the lower rectum. Despite piles being a relatively common issue, many people are embarrassed to speak about them or seek medical attention.

Causes of Piles

Increased pressure on the veins around the anus and rectum is the primary mechanism leading to haemorrhoids. Key factors include:

1. Chronic straining during bowel movements or difficulty in passing stools [2].
2. Prolonged sitting on the toilet [2].
3. Pregnancy, which can cause temporary haemorrhoids due to pressure from the growing uterus; these often resolve after birth [3].
4. Low-fibre diet, which contributes to constipation and straining [2].
5. Heavy lifting, which increases abdominal pressure [2].

Types of Haemorrhoids

Haemorrhoids are broadly classified by their location relative to the dentate line in the anal canal.

1. Internal Haemorrhoids: Located inside the rectum, these are typically painless because they are above the nerves that sense pain. The most common symptom is painless bright red bleeding during or after a bowel movement [4].
2. Prolapsed Haemorrhoids: This occurs when internal haemorrhoids swell and protrude outside of the anus [4]. They can often be pushed back in and are graded based on their degree of prolapse.
3. External Haemorrhoids: These are swollen veins that form under the skin outside of the anus. They can cause pain, itching, and discomfort, especially when sitting or having a bowel movement [4].

Common Symptoms of Piles

The most common symptoms include:

• Painless bright red bleeding during or after a bowel movement (typically internal haemorrhoids).
• Itching or irritation around the anus.
• Swelling or a lump near the anus (external or prolapsed haemorrhoids).
• Pain or discomfort, particularly with external or prolapsed piles.

Complications of Piles

Haemorrhoids can sometimes lead to complications that require urgent medical attention [4]:

1. Thrombosed Haemorrhoid: A blood clot forms within an external haemorrhoid, causing sudden, severe pain [4].
2. Skin Tags: Extra skin left behind after a thrombosed haemorrhoid has healed.
3. Strangulated Haemorrhoid: A prolapsed internal haemorrhoid that has its blood supply cut off by the anal sphincter muscles, leading to severe pain and potential tissue death [4].
4. Anaemia: In rare cases, chronic, significant blood loss from haemorrhoids can lead to iron-deficiency anaemia.

Prevention of Piles

Haemorrhoids can be largely prevented by adopting healthy bowel habits:

• Consuming a diet high in fibre (fruits, vegetables, whole grains) [2].
• Increasing water and other fluid intake [2].
• Avoiding straining during bowel movements [2].
• Limiting the time spent on the toilet seat to only a few minutes [2].
• Maintaining a healthy weight and avoiding frequent heavy lifting.

What is an Anal Fissure?

A fissure, or anal fissure, is a small tear or cut in the moist, delicate lining of the anus (anoderm) [5]. Anal fissures can appear in people of any age, but they are common in infants and middle-aged adults. Both genders are equally impacted.

Causes of Anal Fissures

The tear is usually caused by trauma to the anal lining. The most common causes include:

• Passing large or very hard stools (a key factor in chronic constipation) [5].
• Straining during bowel movements [5].
• Chronic diarrhoea (frequent watery stools can cause irritation) [5].
• Anal trauma (less common, but includes events like childbirth) [5].
• Underlying conditions like Inflammatory Bowel Disease (e.g., Crohn’s disease) [5].

Types of Anal Fissures

Anal fissures are categorised based on how long they have persisted:

1. Acute Fissure: A recent tear that has developed within the past few weeks. Acute fissures typically have sharp, clean edges and often heal on their own within a few weeks with conservative treatment, like stool softeners [6].
2. Chronic Fissure: A tear that has persisted for more than eight weeks [5]. Chronic fissures often show visible signs of the body attempting to heal, such as an enlarged skin tag at the bottom (a sentinel pile) or exposed muscle fibres, making them more difficult to heal without medical intervention [5].

Complications of Anal Fissures

Complications can arise if a fissure does not heal properly:

1. Chronic Pain: Persistent, severe pain that significantly impacts quality of life [5].
2. Muscle Spasm and Non-Healing: The exposed internal anal sphincter muscle can spasm, reducing blood flow to the tear and preventing it from healing (the main mechanism of chronicity) [5].
3. Anal Abscess and Fistula: Though less common, a chronic fissure can sometimes lead to an infection (abscess), which may then develop into an anal fistula (an abnormal tunnel connecting the anus to the skin) [5].

Piles (Haemorrhoids) vs. Fissures: Key Differences

While both conditions affect the same region and share symptoms like bleeding, they are fundamentally different tissue injuries.

Conclusion

Piles and fissures are two common medical conditions that require an accurate diagnosis by a healthcare professional due to their overlapping symptoms. While lifestyle measures like increasing dietary fibre and hydration are cornerstones of initial management for both, treatment can range from topical medications to minor surgical procedures, depending on the severity and type of condition [1].

Early consultation with a primary care physician (MD/DO) or a specialist (such as a gastroenterologist or proctologist) is crucial for effective treatment and to rule out more serious underlying conditions.

Frequently Asked Questions (FAQs)

Can piles and fissures resolve on their own?

Mild, acute anal fissures often heal spontaneously with conservative measures like stool softeners and warm sitz baths [6]. Small, non-thrombosed external haemorrhoids and Grade 1 internal haemorrhoids may also resolve with dietary and lifestyle modifications [2]. However, chronic fissures and more severe piles (Grade 3 or 4) nearly always require medical intervention [4], [5].

How are piles and fissures diagnosed?

Both conditions are primarily diagnosed through a thorough medical history and a physical examination [5]. A healthcare provider will often perform a gentle visual and/or digital rectal examination. In some cases, to rule out other issues or examine the internal area more thoroughly, a short-scope examination (anoscopy or proctoscopy) may be used [5].

References

[1] Gardner, I. (2019). Benign anorectal disease: Hemorrhoids, fissures, and fistulas. Annals of Gastroenterology, 32(4), 346–355. https://doi.org/10.20524/aog.2019.0438

[2] Davids, J. S., & Ridolfi, T. J. (2021). Hemorrhoids. In A. B. Kaiser, S. D. Popowich, & T. J. Ridolfi (Eds.), The ASCRS Textbook of Colon and Rectal Surgery (3rd ed., pp. 209–229). Springer, Cham. https://doi.org/10.1007/978-3-030-66049-9_11

[3] Poskus, T., Sabonyte-Balsaitiene, Z., Jakubauskiene, L., Jakubauskas, M., Stundiene, I., Barkauskaite, G., Smigelskaite, M., Jasiunas, E., Ramasauskaite, D., Strupas, K., & Drasutiene, G. (2022). Preventing haemorrhoids during pregnancy: A multicenter, randomised clinical trial. BMC Pregnancy and Childbirth, 22(1), 384. https://doi.org/10.1186/s12884-022-04688-x

[4] Gilani, A., & Tierney, G. (2022). Chronic anal fissure in adults. BMJ, 376, e066834. https://doi.org/10.1136/bmj-2021-066834

[5] Riboni, C., Selvaggi, L., Cantarella, F., Podda, M., Bracchitta, S., Mosca, V., Cosenza, A., Cosenza, V., Selvaggi, F., Nardo, B., & Pata, F. (2024). Anal fissure and its treatments: A historical review. Journal of Clinical Medicine, 13(13), 3930. https://doi.org/10.3390/jcm13133930

[6] Banerjee, N. A., Roy, P., Moral, R. S., & Chakraborty, S. (2023). An observational study comparing surgical and non-surgical treatment for chronic anal fissures. Asian Journal of Medical Sciences, 14(1), 222–225. https://www.nepjol.info/index.php/AJMS/article/view/46879