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 (haemorrhoids) and anal fissures are two common conditions affecting the anal region. They are often confused due to their overlapping symptoms—pain, discomfort, and bleeding during bowel movements. However, they differ significantly in terms of their underlying causes, clinical presentation, and treatment options.

Both piles and fissures can be treated with lifestyle changes, such as increasing fibre intake and staying hydrated, as well as with medication and surgery in more severe cases. It is essential to seek medical attention if you are experiencing symptoms to determine the appropriate course of treatment. This article will discuss the key difference between piles and fissures so that you can understand these conditions better.

What are Piles?

Piles, also known as haemorrhoids, are a condition where veins in the rectum and anus become swollen and inflamed. They are common and often caused by straining during bowel movements, sitting for long periods, or other factors such as pregnancy.  Despite piles being a relatively common issue, many people are embarrassed to speak about them or seek medical attention.

Causes of Piles 

1. Constipation and prolonged straining during bowel movements are critical factors in causing Piles. 
2. Pregnancy can lead to obstruction of the anal cushion causing  haemorrhoids, but they usually resolve after birth.
3. Dietary factors, such as low fibre diet, spicy foods, and alcohol intake, do not directly cause haemorrhoids but may irritate existing ones.

Types of Haemorrhoids

Piles can be broadly classified into three categories.

Internal haemorrhoids are located inside the rectum, are painless, and tend to bleed.

If you are experiencing rectal bleeding, you will notice bright red blood in your faeces, in the toilet bowl, or on the toilet paper after a bowel movement.

Prolapsed haemorrhoids are a type of external haemorrhoid those  have  protruded outside of the anus. It occurs when the swollen  veins in the haemorrhoid stretch the anus and become displaced.

External haemorrhoids are swollen veins that form outside of the anus. They can cause pain, itching, and discomfort, especially when sitting or having a bowel movement.

Symptoms of haemorrhoids are as follows:

• Bright red bleeding during or after a bowel movement
• Itching or irritation around the anus
• Swelling or a lump near the anus
• Pain or discomfort, especially with external or prolapsed pilesThe manifestations of external haemorrhoids typically disappear for most people within a few days.

Read Also: Piles (Haemorrhoids) in Women: Symptoms, Causes and Treatment

Complications of haemorrhoids

Haemorrhoids can lead to the following complications:

• Blood clots in an external haemorrhoid.
• Skin tags are the extra skin left behind when a blood clot in an external haemorrhoid heals.
• Infection of a sore on an external haemorrhoid
• Strangulated haemorrhoid, which happens whenever the muscles around your anus cut off the supply of blood to an internal haemorrhoid that has fallen through your anal opening
• Anaemia 

Prevention of Piles 

Haemorrhoids can be prevented by

• Consuming foods  high in fibre
• Increasing water (and other fluids) intake
• Avoiding strain during the bowel movement
• Not spending too much time on the toilet seat
• Not lifting heavy things too often

What is an anal fissure?

Fissures, or anal fissures, are minor cuts or tears in the lining of the anus caused by trauma or straining during a bowel movement. Anal fissures can appear in people of any age; However, they are most commonly seen in children and middle-aged people. Both genders are equally impacted.

Causes of Anal fissures

The following are the causes of Anal fissures.

• Chronic constipation
• Straining during bowel movements
• Passing hard stools
• Anal trauma (including childbirth)
• Inflammatory bowel diseases (e.g., Crohn’s disease)
• Chronic diarrhoea

Types of Anal fissures 

Depending upon the severity of the condition, anal fissures can be categorised into

Acute Fissure:

An acute fissure is a small tear in the skin around the anus that has developed recently and is causing symptoms such as pain and bleeding during bowel movements. It is usually caused by trauma to the area, such as passing hard stools or straining during bowel movements. In most cases, acute fissures heal on their own within a few weeks with proper treatment. However, if the fissure persists for more than eight weeks, it may become chronic and require further treatment.

Chronic Fissure

A chronic fissure is a small tear in the skin around the anus that has persisted for more than eight weeks and has not healed on its own. Chronic fissures may involve exposed muscle fibres, sentinel piles, or hypertrophied anal papillae.

Complications of Anal fissures

1. Chronic pain: If an anal fissure does not heal properly or is left untreated, it can cause chronic pain and discomfort, significantly impacting a person’s quality of life.
2. Infection: If bacteria enters the anal fissure, it can cause an infection, which can be painful and require medical treatment.
3. Abscess: An anal abscess can occur if bacteria infect the anal fissure and cause a collection of pus. It can be excruciating and may require surgical drainage.
4. Fistula: An anal fistula can occur if an abscess does not heal properly and leads to formation a tunnel between the anus and the surrounding skin. It can cause chronic pain and discomfort and may require surgical treatment. 
5. Incontinence: In rare cases, chronic anal fissures can lead to incontinence, which is the inability to control bowel movements.

Piles vs Fissures

Hemorrhoidal veins, or piles, are enlarged in the anus or lower rectum. Pain, itching, and bleeding during bowel movements are piles symptoms. Numerous causes, such as constipation, pregnancy, or obesity, can contribute to them.

Contrarily, fissures are tiny tears in the skin near the anus. They may result from inflammatory bowel disease, persistent diarrhoea, or passing hard stools. Fissures can cause itching, discomfort, bleeding during bowel movements, and other symptoms like pain.

Treatment of Piles and Fissures

While these conditions may have different underlying causes, they share some common symptoms, and several medications can relieve the associated discomfort. Even though there is a difference between piles and fissures, there are a few medications that can be used to treat both.

Here are some of the best medicine for piles and fissures:

Painkillers: Painkillers such as ibuprofen or acetaminophen can help to relieve the pain associated with piles and fissures. However, these should be taken only under the guidance of a doctor, as they can have side effects and may interact with other medications.

Topical creams and ointments: Topical creams and ointments are available over-the-counter and can relieve the itching, burning, and pain associated with piles and fissures. They may contain ingredients such as lidocaine, hydrocortisone, or witch hazel, which can help to reduce inflammation and soothe the affected area.

Suppositories: Suppositories are another option for treating piles and fissures. These small, round capsules inserted into the rectum contain medications such as hydrocortisone or zinc oxide, which can help reduce inflammation and relieve pain and itching.

Stool softeners: Stool softeners help relieve constipation by making it easier to pass stool. They draw water into the bowel to soften the stool, making it easier to pass. Stool softeners are available in oral capsules, tablets, and liquids. Docusate sodium, Polyethylene glycol (Miralax), Mineral oil, and Lubricant laxatives. 

Nitroglycerin ointment: Nitroglycerin ointment is a medication that can help relax the sphincter muscle and improve blood flow to the anal area, promoting the healing of fissures.

Conclusion

Piles and fissures are two common medical conditions affecting the anal region.  It is essential to get medical attention if you experience symptoms of piles or fissures, as these conditions can be effectively treated with proper diagnosis and treatment. Additionally, practising good anal hygiene and maintaining healthy habits can help prevent the development of these conditions.

Frequently Asked Question (FAQs)

References 

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• Gilani, A., & Tierney, G. (2022). Chronic anal fissure in adults. BMJ, e066834. https://doi.org/10.1136/bmj-2021-066834
• Davids, J. S., & Ridolfi, T. J. (2021). Hemorrhoids. The ASCRS Textbook of Colon and Rectal Surgery, 209–229. https://doi.org/10.1007/978-3-030-66049-9_11
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