Comparison Between Piles and Fistula - A Comprehensive Guide

piles vs fistula difference

Symptoms of piles, and symptoms of fistula are often misunderstood or confused due to their similarities. However, they are distinct conditions affecting the anal area. Hemorrhoids, or piles, are caused by enlarged blood vessels in the rectum or anus, which can be painful and bleeding. Conversely, a fistula, which frequently results in chronic pain and discharge, is an anomalous tunnel between the skin surrounding the anus and the anal canal.

For an appropriate diagnosis and course of treatment, it is essential to comprehend the distinctions between these conditions. So, let's dispel the mystery surrounding these frequently interchangeable medical conditions by delving deeper into their traits, manifestations, and modes of treatment.

What are Piles?

Hemorrhoids, or piles, are enlarged, inflamed veins in the rectum and anus that can occasionally bleed. They can also cause pain, discomfort, and itching. They may appear externally around the anal opening or internally within the rectum.

One of the main causes of piles is the increased pressure of the lower rectum. Their development may be aided by elements such as straining during bowel movements, persistent constipation or diarrhoea, obesity, pregnancy, a sedentary lifestyle, and a diet deficient in fibre.

There are two main types of haemorrhoids:

  • Internal haemorrhoids: These develop within the rectum and may not be visible or felt. However, they can cause bleeding when irritated during bowel movements. Internal haemorrhoids can also prolapse, meaning they protrude outside the anal opening, causing discomfort and pain.
  • External haemorrhoids: These form under the skin around the anus and can be felt as a painful lump. They may cause itching, bleeding, or discomfort, especially during activities like sitting or bowel movements.

Managing piles often involves lifestyle changes like increasing fibre intake to soften stools, drinking plenty of water, and avoiding straining during bowel movements. Suppositories, ointments, and creams available over the counter can help ease pain and itching-related symptoms. Sclerotherapy, rubber band ligation, or surgical excision may be required in extreme cases.

While piles can be uncomfortable and sometimes painful, they're a common condition and can often be managed effectively with lifestyle changes and proper treatment. Seeking medical advice for persistent or severe symptoms is crucial to determine the best course of action for managing piles.

What is Fistula?

An abnormal passageway or connection between two organs, vessels, or other body structures is called a fistula. An injury, an infection, inflammation, or post-operative complications can bring it on. The skin, reproductive organs, urinary tract, and digestive tract are among the body parts where fistulas can form.

Fistulas come in a variety of forms, contingent on their origin and site. Some common types include:

  • Gastrointestinal fistulas: These can develop between the intestines and other organs like the stomach, bladder, or skin, or they can form between the intestines and one another. They could be brought on by illnesses like diverticulitis, Crohn's disease, or surgical complications.
  • Urinary Fistulas: These involve abnormal connections between the urinary tract organs, such as the bladder, urethra, or kidneys. Infections, trauma, or surgical complications can cause them.
  • Anorectal Fistulas: These occur in the anal region and can cause discomfort, pain, and discharge. They often develop due to an infection in the anal gland.
  • Obstetric Fistulas: Common in developing countries, obstetric fistulas result from prolonged obstructed labour, leading to a hole between the vagina and nearby organs like the bladder or rectum.

Depending on where they are located, fistulas can cause a range of symptoms, including pain, inflammation, infection, abnormal discharge, and problems with regular bodily functions like bowel or urine movements. Imaging tests, such as CT scans, MRIs, or specialised exams tailored to the affected area, are frequently used in the diagnosis process.

Treatment for fistulas usually involves addressing the underlying cause, surgical intervention to close the abnormal passageway, and sometimes medications to manage symptoms or prevent infection. Depending on the kind and location of the fistula, management may need a multidisciplinary approach involving specialists such as gastroenterologists, urologists, or surgeons. Early detection and appropriate treatment are essential to avoid complications and enhance the patient's quality of life.

Comparison Table (Piles and Fistula)

Piles and fistula are two distinct medical conditions affecting the anal region, although they differ significantly in their nature, causes, symptoms, and treatment approaches. Here's a concise comparison table highlighting their key difference





Also known as haemorrhoids, swollen blood vessels in the anal canal 

An abnormal tunnel-like tract between the anal canal or rectum and the skin near the anus 

Causes of piles, Causes of fistula


Straining during bowel movements, chronic constipation, pregnancy, obesity 

Often develops from an untreated or recurrent anal abscess, Crohn's disease, infection in the anal glands 

symptoms of piles, symptoms of fistula


Itching, pain, bleeding during bowel movements, protrusion of swollen tissue 

Persistent anal pain, discharge of pus or blood, swelling around the anus 


Physical examination, digital rectal exam, sigmoidoscopy, colonoscopy 

Physical examination, MRI, epistolography, CT scan 


Internal (inside the rectum) and external (outside the rectum) 

Simple (a single tunnel) and complex (multiple tracts or branches) 

Piles treatment, Fistula treatment


High-fibre diet, topical treatments, sclerotherapy, rubber band ligation, surgery (hemorrhoidectomy) 

Antibiotics, surgical procedures (fistulotomy, fistulectomy, seton placement) 


Anaemia due to chronic bleeding, thrombosis, strangulation of haemorrhoids 

Recurrence, abscess formation, infection, incontinence, difficulty healing 


Generally treatable with lifestyle changes or medical intervention 

Often requires surgical intervention for complete resolution 

Understanding the key differences between piles and fistulas helps in accurate diagnosis and appropriate treatment selection, considering the distinct nature and potential complications associated with each condition. Consulting a healthcare professional is crucial for proper evaluation and management tailored to individual needs.


In summary, while both piles (haemorrhoids) and fistula are conditions affecting the anal region, they differ significantly in their nature, symptoms, and treatments. Piles involve swollen blood vessels in the rectum or anus, causing discomfort, bleeding, and pain. Conversely, fistulas form abnormal tunnels between the anal canal and the skin around the anus, resulting in persistent drainage and recurrent infections.

Recognising the dissimilarities between these conditions is crucial for accurate diagnosis and appropriate treatment. While some symptoms might overlap, seeking prompt medical advice and undergoing proper examination is pivotal for effective management. Understanding the difference between piles and fistula empowers individuals to navigate the nuances of these conditions and seek targeted medical care, ensuring better health and well-being.