Piles v/s Fissures: What Are They?



Have you at any point suffered from an irritable and itchy anal cavity? Or had trouble in passing stool, noticed blood in stool? Or you experienced discomfort after sitting for an extended period. If you have, then you must have also found it challenging to come to a correct diagnosis. Piles v/s Fissures, what is it that is troubling you?

A report suggests that half of the Indian population suffers from piles. Other reports show that around 20% of this population suffers from piles and anal fissures.

Most of us may be unable to tell the difference between the two since they co-occur.  But fear not; there’s nothing major to worry about. You can quickly eliminate them once you distinguish between them and opt for the proper treatment.

Let us get familiar with the terms and the fundamental differences and symptoms of these diseases. Piles v/s Fissures; which one is more harmful and which one is easily treatable?

What Makes Piles and Anal Fissures Different From Each Other?


The blood vessels, tissues, and muscles in the anal area get swollen or inflamed, called piles or hemorrhoids. Some common causes of piles are long-term constipation, eating hot and spicy food, and prolonged sitting.

Such habits and issues put a lot of pressure on the veins in the anal area. The pressure then causes the tissues and veins to swell up and expand. The result is an inconvenience to the patient and, at times, the passing of bloody stool.

The disease has 4 different grades of classification. Physical symptoms start appearing after the disease has crossed the second grade. Piles are of two types- internal and external, and one should understand and monitor the symptoms.

Grade 1: This is in the early stage, and at this grade of piles, the apparent symptoms are not visible or felt. Hence they do not cause much pain and discomfort to the patient.

Grade 2: This is called the prolapsed stage of piles. In this grade, hemorrhoids or Piles protrude out when stool passes from the anal opening. After the bowel movement, it retracts on its own.

Grade 3: This is where the Piles start becoming painful for the patient. The hemorrhoid comes out from the anal opening and does not retract. They need to be pushed back by fingers.

Grade 4: This grade is extremely painful and unbearable for the patient. The hemorrhoid remains protruded and causes massive discomfort. One may face difficulty sitting or lying down or notice blood in their stool.

The main difference between internal and external piles is that internal piles are painless but cause bleeding inside the rectum, and external piles are painful and found outside the anus.

Symptoms to look out for:

  1. Itching in the anal cavity
  2. Sticky mucus in underwear or toilet paper on wiping the anus
  3. Pain or discomfort in the anal opening while sitting
  4. Swelling, inflammation, or bleeding around the anus
  5. One or more firm bumps that are tender near the anus

What are its causes?

  • Constipation
  • Dysentery
  • Sexually Transmitted Infections/Diseases
  • Inflammation in the Intestines (Crohn’s Disease and Ulcerative Colitis)
  • Childbirth or Pregnancy
  • Tuberculosis
  • Human Immunodeficiency Virus

What are the complications it can cause?

  • Piles can result in blood clots externally
  • Infection in external piles
  • Skin tag or extra skin is left behind when a blood clot heals in external piles
  • Strangulated piles occur when anal muscles cut off the blood supply to internal piles, causing thrombosis. Blood clots appear in the affected area
  • Anaemia

What steps should you take for piles prevention?

  • Consume fiber-rich food such as fruits, leafy vegetables, oats, salads, etc
  • Increase your water intake along with healthy fluids and fresh juices
  • Avoid straining too much while passing stool
  • Only spend a little time on the toilet seat, especially if your efforts are worthless and painful
  • Avoid lifting heavy things frequently or too often.

How can you get piles treated?

You can treat piles with a lifestyle change. Opt for a healthy style, and you could say goodbye to piles. Pick a healthy eating habit and a balanced diet, and you will be free. Your diet and lifestyle matter.

Other simple things you can do for treatment are switching from cold water baths to bathing in warm water. Make sure to use a good ointment for the swelling, which can help reduce some of the pain and discomfort caused by piles.

However, a doctor can perform an endoscopic treatment if your piles are not easily treatable through lifestyle changes. There are three methods from which the doctor can choose. These are the Injection Therapy, Band Litigation, and Infrared Coagulation.


Fissures, or anal fissures, are cuts or tears in the anal area. Extremely hard stool that is tough to pass from the rectum cuts or tears on the delicate skin around the anus. These cuts and tears usually occur around the opening of the anus.

Anal fissures make the passing of stool painful and difficult, leading to constipation. The sphincter muscles feel uneasy in passing stool, putting immense pressure. You may notice a discharge of light bleeding or pus during bowel movements.

Anal fissures generally have two stages; Acute or Chronic. An acute fissure is not much severe or complicated and gets healed over some time.

Chronic Fissure, however, needs medical attention. The possibilities of reoccurrence are high and require medical supervision.

Symptoms of anal fissures to look out for:

  1. Severe pain in the affected area
  2. Bleeding during bowel movement
  3. Tightening of the Anus followed by a sharp spasm.
  4. Painful boils filled with pus.
  5. Mucus-like foul-smelling discharge

Common causes of anal fissures:

  • Chronic Diahorrea
  • Constipation
  • Crohn’s Disease
  • Anal Intercourse
  • Anal Cancer
  • Human Immunodeficiency Virus
  • Tuberculosis
  • Childbearing
  • History of Anal Surgery

What sort of complications can anal fissures cause?

  • Infection due to bacteria entering into the anus
  • Chronic pain
  • Abscess because of bacteria and collection of pus
  • Fistula if the abscess doesn’t heal properly
  • Incontinence or inability to control bowel movement

How can you prevent the complications?

  • You should ensure the stool is neither too hard (constipation) nor easily passable (diarrhea)
  • Have a fibrous diet and drink appropriate water for timely and proper bowel movements
  • Avoid eating junk food frequently
  • Avoid straining while passing stool
  • Control and restrict the consumption of caffeinated drinks
  • Stay away from alcohol

How can you get anal fissures treated?

Anal fissures can be treated with stool softeners, and ensure you consume the right amount of water daily. Acute fissures don't require medical surgery. The standard treatment for acute anal fissures is to make your stool bulky and well-formed.

Topical anesthetics like lidocaine soothe anal pain, and Sitz baths for 10-20 minutes two to three times a day can help relax the anal muscles, which helps with the healing.

These non-operative and easy methods can heal more than half of the acute anal fissures. These methods usually have no side effects. Chronic fissures, on the other hand, can be challenging to treat and may require surgery.

Piles v/s Fissures: Key Differences

Let’s look at some critical differences between Piles and anal fissures.



  • Piles are swollen or inflammatory veins in the anal canal, opening, or rectum.

  • Anal Fissures are tears or cuts in the delicate anal skin. 

  • Piles are not painful initially but become painful when the swelling turns severe. 

  • Anal Fissures are painful from the start of the initial stage of diagnosis. They make the patient very uncomfortable with pain and bleeding.

  • Piles are caused by prolonged constipation, sitting for an extended period, physical strain, pregnancy, or chronic cough. 

  • Fissures are caused due to constipation or diarrhea, injury in the anal cavity, obesity, or Crohn’s disease.

  • Piles can be treated with Endoscopic Treatment at a higher stage.

  • Fissures need surgery for treatment at a higher stage. 


Piles v/s fissures comparison shows that anal fissures are more severe and painful.  They cannot always be treated with lifestyle changes or dietary improvements. It requires surgery to be treated in extreme conditions, whereas endoscopy can cure Piles through Injection, Band litigation, or infrared treatment, as mentioned above.