Piles, fissures, and fistula are three related medical conditions that sound identical. As they even occur in the same part of the body, they are assumed to be similar to one another. However, that is not the case. Each of these conditions is as difficult to one another as is pain and discomfort caused by them. 

In simple terms, piles are enlarged rectal veins, a fissure is a sharp cut in the anal lining, and an anal fistula is an irregular canal in the rectal wall. But there’s more to these rectal disorders than meets the eye. 

Even the basic definitions of the terms fistula and fissure are more different than one may assume. A “fistula” in medical terms, is a channel resembling tubes between organs while a “fissure” refers to a skin tear. Consequently, a little tear or split in the wall of your anus is known as an anal fissure. This cut, however small, causes excruciating pain accompanied by blood during and after passing stools.

An anal fistula is an inflamed passageway between the skin and the anus. It is a type of a pus-filled anal blister that irritates the inner rectum and anal veins. Piles, on the other hand, appear inside the rectum or surrounding the anus and may develop into uncomfortable clots close to the anus. 

But how do we tell the difference between each of these terms and how do we differentiate their symptoms from one another? Keep reading below to know all this and also find out the best way to treat fistula, fissures, and piles. 

What are anal disorders?

The anus is the part of the intestinal system that travels through the anal sphincters and neuromuscular canal of the pelvis. It is the body’s last opening via which food wastes are excreted from the system. 

The anus measures 4 to 5 cm in length in adults, and the anal canal’s lower half is lined with delicate nerve fibers. It also contains numerous arteries and several microscopic anal glands. Any disturbance to this canal in the form of a tear, external pressure or blockage can cause an anal disorder. Here are some major anal disorders that might need immediate medical assistance. 

  • Anal fissure

A longitudinal split or tear in the anoderm that lines the lower anal canal is an anal fissure, also known as an anorectal fissure. Most anal fissures are caused by big, hard stools that can stretch the anal orifice past its limit and rupture the delicate anoderm.

Anal fissures are less frequently induced by chronic diarrhea, inflammatory bowel illness, or STIs that affect the anorectal region. Acute (short-term) anal fissures are typically superficial and shallow. Persistent (long-term) anal fissures may go deeper into the anoderm to reveal the underlying muscle layer. 

  • Anal abscess

A painful, pus-filled swelling close to the anus is known as an anal abscess. Most anal abscesses develop independently for unknown reasons unrelated to other medical conditions. They start in the microscopic anal gland that enlarges due to an infection site beneath the skin.

Anal abscess affects more than 50% of young adults aged 20-40 worldwide and is more frequent in men than in women. Most anal abscesses are found close to the anus’ opening and might sometimes develop higher up or deeper in the anal canal, closer to the pelvis or lower intestine.

  • Anal fistula

A drained anal abscess leaves behind an abnormally small, tunnel-like tube known as an anal fistula. It connects the anal canal to the surface of the skin. An anal fistula will grow at least 50% after an anal abscess has emptied (either naturally or mechanical stress).

Sometimes pus or red fluid is discharged continuously from the fistula’s opening at the skin’s surface. In some instances, the fistula’s entrance temporarily closes, reactivating the original anal abscess as a severe pus pocket.

  • Hemorrhoids

While hemorrhoids do not hurt, minor bleeding around the anal orifice’s border can cause the blood vessels to thicken (“thrombosis”). A bout of diarrhea or constipation is the most prominent symptom, and external hemorrhoids become large, hard, and painful and occasionally discharge blood when thrombosis occurs.

How to Differentiate between Piles, Fissures, and Fistulas?

  • Piles

Piles are a group of enlarged veins and tissues in the lower rectum and anus. They can occur either on the inside or outside of the body. External hemorrhoids form on the skin surrounding the anus, and internal hemorrhoids form inside the anal canal. The size of these hemorrhoids can vary depending on the clots. Constipation, persistent diarrhea, carrying heavy objects, pregnancy, and straining when passing stools are the common causes of piles.

While Hemorrhoids typically go away on their own and don’t need medical attention, treatment is required in case the condition worsens. The type and location of the piles affect the extent of symptoms and discomfort experienced by patients. 

External hemorrhoids can cause various symptoms, including swelling, bleeding, pain, and irritation in the anal area. Internal hemorrhoids, though not visible, can be equally or more painful than external piles and are known to bleed while passing stools. Internal hemorrhoids that protrude from the anal canal cause more discomfort and make normal tasks like sitting or sleeping.

  • Anal Fissures

An anal fissure is a rupture in the mucosa, the inner lining of the rectal wall. When the skin tears, it bleeds profusely during and after bowel movements. An anal fissure can afflict people of any age, though it is most frequently- observed in infants and young children. The fissure typically heals by itself in a month to six weeks. However, if it continues after then, it may be regarded as chronic. The fissure can occasionally be deep enough to reveal muscle tissue.

Constipation, struggling during bowel motions, passing large, hard stools, diarrhea, delivery, and anal intercourse are the most typical causes of an anal fissure. The following signs and symptoms of an anal fissure involve mild to severe distress during bowel movements.

A noticeable tear or crack on the skin around the anus, a small bulge close to the tear, streaks of blood after passing stools on the toilet seat or the tissue paper, and pain that persists for a long time after bowel movements.

  • Anal Fistula

A tiny underpass is an anal fistula that forms close to the anus between the anal canal and the skin. They frequently arise from an infection close to the anus that results in an abscess. A tiny tube may remain left once the pus drains. The center of the anus becomes infected in the fistula and creates an abscess that begins to seep pus.

Piles Symptoms & Characteristics

The majority of the time, piles symptoms are not dangerous. After a few days, they typically resolve on their own. Someone with piles could experience the following signs and symptoms:

  • Around the anus, a firm, potentially painful lump begins forming. It might have coagulated blood in it. Blood-filled masses are referred to as thrombosed external hemorrhoids.
  • A person with piles could feel like their bowels are still full after releasing a stool.
  • When you have a bowel movement, bright crimson blood is seen. Itchy, red, and painful skin is present around the anus.

How to Treat Piles?

Doctors perform rubber band closure surgery to treat internal hemorrhoids or piles that are bleeding or prolapsing. In addition, a medical expert wraps a specific elastic band around the hemorrhoid’s base. The band stops the flow of blood. Usually, within a week, the banded portion of the hemorrhoid dwindles and comes off.

It frequently contracts when scar tissue develops in the hemorrhoid’s residual area. You should never- attempt this treatment on your own; only a doctor should carry it out.

A surgeon inserts a solution into an internal hemorrhoid to produce scar tissue, and the Hemorrhoid frequently gets more undersized because the scar tissue cuts off the blood flow.

An abdominal hemorrhoid is treated by a doctor using a device that emits infrared light. The infrared light’s heat induces scar tissue to develop, cutting off the blood flow and frequently decreasing hemorrhoids.

In another treatment, a medical professional employs a device that injects electricity into internal hemorrhoids. With this treatment, Hemorrhoid gets smaller due to the electric current’s formation of scar tissue, which shuts off the blood supply.

Fissure Symptoms & Characteristics

A small rip in the mucosa, a delicate, moist tissue surrounding the anus, is an anal fissure. When you produce large or hard feces during a bowel movement, an anal fissure may develop. Anal fissures frequently result in discomfort and bleeding during bowel movements. Additionally, the muscle ring at the end of your anus may spasm (anal sphincter).

Symptoms that continue for longer than six weeks are regarded as long-term or chronic. Chronic anal fissures could be more difficult to treat and a sign of another ailment, like Crohn’s disease or ulcerative colitis.

How to treat fissures?

More than half of all fissures heal independently or without medical intervention. In addition, painkillers for bowel movements include stool softeners, and antibiotics are occasionally permitted. It is also possible to use specific medicinal creams to reduce symptoms and aid in the healing process. Nitroglycerin ointment administered to the anal canal is a common treatment. The norepinephrine in this drug must be diluted because it is used to treat coronary angina and contract blood vessels that increase blood flow.

The anus and the region in between the buttock need to be kept dry and clean. The patient should use a soft cloth to pat dry the anal area after a bath gently. Applying talc could be beneficial. Sitz baths might ease pain and encourage recovery. A sitz bath immerses the anal region for 15-20 minutes, several times a day, in plain warm water that is not heated.

The doctor reexamines the patient if the fissure is not improving after treatment. Conditions like muscle spasms or scarring may prevent the body from mending properly. Surgical intervention can be used to treat fissures that do not heal. It is a simple procedure that is frequently completed without hospitalization.

The surgeon cuts away the scar tissue beneath the fissure. The anal muscle can get partially cut to reduce spasms and increase blood flow. It promotes healing in the area and infrequently issues bowel movement control. In a few weeks, the wound fully heals. However, the discomfort frequently goes away within a few days.

In addition, more than 90% of individuals who require surgery for fissures don’t experience any more issues. Maintaining a sufficient fiber intake in the diet will assist patients in preventing the recurrence of fissures.

Piles vs. Fissures vs. Fistula

ComparisonPilesAnal FissuresAnal Fistulas
DefinitionIt is the medical condition of the inflammation of tissues and veins of the anal area.A small tear or cut in the lining of the anus that induces bleeding and inflammation of the anus is called an anal fissure.In the fistula, an abnormal track forms between the skin near the anus and the anal canal. It induces bleeding along with the discharge of pus.
SymptomsBloodstained stools, painful and strainful bowel movements, lump shape near the anus, frequent discharge because of the pus, itching around the anus, soreness, and redness of the skin of the anus.A tear or cut that is visual in the skin of the anus. In addition, it causes severe pain during bowel movements and bloodstains on stools. Furthermore, patients can feel a burning sensation near the anus and feel full bowel even after passing stools numerous times.Swelling and pain in the anal area, along with painful bowel movements. Furthermore, patients can cause foul-smelling discharge seeping out of the entrance of the anus. Bleeding while passing stools, irritation and soreness of the skin near the anus, and fever and chills in severe cases are also prominent.
CausesChronic constipation, lethargic lifestyle, recurring diarrhea, additional body weight, and strainful bowel movementsPassing large and hard stools due to constipation can cause a tear in the anal skin, anal cancer, chronic diarrhea, rough anal intercourse, sexually transmitted infections, and inflammatory bowel disease such as HIV, AIDS, syphilis, etc.Inflammatory bowel disease (Crohn’s disease), sexually transmitted infections, Cancer treatment (radiation therapy).
Preventive measuresConsume foods rich in dietary fiber and sip considerable water and healthy fluids. Moreover, keeping an occupied lifestyle is beneficial as avoiding sitting for long hours is beneficial.Take a more fiber-rich diet and keep hydrated by drinking healthy fresh juices. Reducing the intake of caffeinated and carbonated drinks can cause dehydrationAll the preventive measures for fistula and piles work effectively for fistula too

What are the Complications Associated with Piles, Fissures, and Fistula? 

Hemorrhoids are often seen as a minor and widespread issue, but in rare instances, they may present more aggravating signs and symptoms. Hemorrhoids and fecal soiling are sometimes present, and there may also be a sensation that the bowel hasn’t been emptied after using the restroom.

Acutely thrombosed hemorrhoids are unusual external hemorrhoids with blood pooling inside and occasionally clotting. Outside the anus, this form of hemorrhoid may feel like a solid, painful mass the size of a marble and cause inflammation.

External hemorrhoids may be continuously drooped if it prolapses and cannot be pulled back inside. Rarely, the droop can result in issues such as infection and a lack of blood circulation to the area.

Hemorrhoids can be extremely painful and chronic, although they typically do not lead to other problems. A thrombosed hemorrhoid may occasionally rupture. At the same time, there may be additional bleeding and discomfort. As a result, the ruptured area often heals on its own. A skin tag may occasionally develop at the site of a healed thrombosed hemorrhoid.

On the other hand, a minor tear or cut in the anus wall is referred to as a fissure. It may occasionally be deep enough to reveal the muscle tissue beneath. Anal fissures can be excruciatingly painful and might result in gastrointestinal hemorrhage. 

It is not seen as an exceptionally severe ailment and often cures in a month or two. If it continues after that, it can be referred to as a chronic fissure, and a surgical procedure is rarely required. Anal fissures are typically brought on by constipation or persistent diarrhea. The lining of the anal channel may get inflamed while passing feces that is dense and firm. Tears and wounds may result from this, similar to constantly dropping poop while experiencing diarrhea.

Complications from fistulas are linked to fatigue, death, and significant issues that might drain your finances. However, you must note that no published systematic review has examined the complications of fistula complications related to aneurysms, infection, thrombosis, and venous hypertension when the fistula matures. 

Preventive Steps to Avoid Piles

Follow these preventive measures to avoid piles: 

  • Include Fiber in the Diet

People who have irregular bowel movements are more susceptible to hemorrhoids. Filling up on fiber through your diet or supplements is one of the simplest, most natural ways to improve your regularity. Both family physicians and gastroenterologists agree that adding fiber to the diet is a good idea, and you must try to consume 25 to 30 grams of fiber.

  • Consume More Water 

Even though this method of hemorrhoid avoidance is easy and affordable, very few people use it. The secret to having regular bowel movements is to drink enough water and eat a healthy, fiber-rich diet. As a result, straining is reduced, and drinking adequate water helps prevent constipation. In addition, your entire body benefits from drinking six to eight glasses of water daily, not just your digestive system.

  • Exercise Frequently 

Exercise and hemorrhoids have a love-hate relationship, as exercise keeps the intestines functioning well. Hemorrhoids, however, can develop as a result of exerting oneself in ways that raise abdominal pressure and strain (like weightlifting). You can spend less time sitting and alleviate pressure on your lower rectus veins by remaining active. And if you have a history of troublesome hemorrhoids, you must avoid heavy lifting and other strenuous activities in favor of more moderate activity regimens like yoga, swimming, or walking.

  • Cautious use of laxatives 

Some fiber supplements, especially psyllium capsules, have a history of helping constipating people get more regular, which can help prevent uncomfortable hemorrhoids. As far as laxatives are concerned, they can be helpful if you pick the right ones. The safest laxatives cooperate with your body instead of stimulating or mimicking normal physiological processes. 

In addition, some laxatives function by causing the intestinal wall to contract, which helps the contents pass through. It could worsen hemorrhoid symptoms and pressures. Patients can even use osmotic laxatives, which merely increase the quantity of water in the gut and improve constipation, to treat or prevent hemorrhoids.

Preventive Steps to Avoid Fissures

Anal fissure treatment aims to reduce stress on the anal canal and allow for passing seamless stools to relieve pain and bleeding. Hence the first step is to take conservative precautions.

To prevent constipation, using stool softeners, increasing fluid intake while avoiding products that include caffeine, and changing your diet are important measures. So to accomplish this, try spending 10 to 20 minutes in a warm bath (often referred to as a sitz bath) multiple times daily to relax the anal muscles.

Furthermore, it is crucial to refrain from straining when going to the bathroom. Using these methods, most fissures heal within a few weeks to months. Other options can be considered if conventional treatments are ineffective and anal fissures continue to exist or recur.

An internal anal sphincter muscle spasm or scarring might prevent a fissure from healing. Surgery often entails severing a tiny part of the internal anal sphincter muscle to reduce discomfort and spasms and improve recovery. Anal fissure surgery is performed as an outpatient, and you can anticipate returning home that day. After surgery, the discomfort goes away in a few days, and recovery takes a few weeks.

Preventive Steps to Avoid Fistula

A surgical drainage procedure is often used to treat an abscess. Your surgeon must have extensive experience managing fistulas and abscesses; colorectal surgeons are specialists in this case. Most people can have an abscess surgically drained through a straightforward surgery. A skin incision close to the anus is done to drain the infection. 

Local anesthetics may be used for this procedure at your surgeon’s clinic, or general anesthesia may be used in the operating room. Multiple surgeries may be necessary for certain people with more serious illnesses to address the issue. Hospitalization may be necessary for those with diabetes or immune system issues who frequently suffer more serious illnesses.

Anal fistulas are almost typically treated surgically. If the fistula is not too deep, a fistulotomy is frequently performed on patients. The fistula track will be opened during this procedure to enable healing from the inside out. The sphincter muscle may need to be divided to complete the procedure.

The sphincter muscle is not divided widely since doing so could cause issues with bowel control (fecal incontinence). Additionally, more extensive operations are performed to treat the fistula without hurting the sphincter muscle if the fistula track does involve a significant section of the sphincter muscle. Multiple procedures may be necessary in more complicated cases.

The bottom line 

Normally, anal fissures and piles are not a problem, but if a bloated knot-like structure develops around the anus entrance, they may become severe. This structure’s creation frequently denotes the existence of numerous enlarged blood vessels, which causes pain and discomfort. Internal hemorrhoids may become “strangulated,” which can be extremely painful if the blood supply is turned off. On rare occasions, a clot might develop in a hemorrhage (thrombosed hemorrhoid).

On the other hand, anal fissures that take a long time to heal can cause complications. It is advised to have medical monitoring in such circumstances. Fistulas cannot get cured at home, and they require medical attention. All fistula treatments remove the infection from the patient and return their life to normal using a combination of medication and surgery. Moreover, fistulas that are left untreated can grow into more fistulas, which makes surgery and treatment more challenging and increases the likelihood of recurrence.

In case you suspect any of the symptoms discussed above or are suspicious of your bowel movements, it is always better to see professional help. The sooner you can diagnose the condition and differentiate it from the many rectal conditions, can you begin to seek treatment. Ayu Health Hospitals are the best place to get accurate diagnoses and treatments for all your rectal problems.