How do you tell a hemorrhoid from an anal fissure?
Medically reviewed by Dr. Robert William, MD · Written by Kevin Schwaner · Updated July 2026
Quick Answer
A hemorrhoid is a swollen vein that causes a lump, itching, and painless or mildly painful bleeding. An anal fissure is a small tear in the anal lining that causes sharp, knife-like pain during and after a bowel movement, often with a streak of blood. Fissure pain is more intense and cutting; hemorrhoid discomfort is more of an ache, itch, or pressure.
Both follow hard stools and straining, and both can bleed, but they feel different. A hemorrhoid is a swollen vein, so it tends to produce a lump or fullness, itching, and bleeding that is often painless (internal) or a dull ache (external). An anal fissure is a small split in the skin of the anal canal, so it produces a sharp, tearing, or burning pain during a bowel movement that can linger for minutes to hours afterward, usually with a thin streak of bright blood.
The distinction matters because treatment overlaps but differs. Both benefit from fiber, water, and sitz baths, but fissures are specifically helped by keeping stool soft and, if chronic, by prescription treatments. Fissures that do not heal within a few weeks, or any uncertainty about the diagnosis, warrant a doctor visit.
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Sources
- NIH / NIDDK: Hemorrhoids
- ASCRS Clinical Practice Guidelines for the Management of Hemorrhoids
Related Questions
What is the difference between internal and external hemorrhoids? →When should you see a doctor for hemorrhoids? →How do you stop a hemorrhoid from bleeding? →*Informational only, not a substitute for professional medical advice. Any rectal bleeding should be evaluated by a doctor. These statements have not been evaluated by the FDA.