Benign Anorectal Disease: Hemorrhoids, Fissures, and Fistulas

Hemorrhoids, fissures, and fistulas

You might be wondering how pain in the rectal region can have so many different reasons. It didn't use to be this way in the past. But, as science evolved, so did our understanding of the human body, particularly in terms of health and disease.

The chances are that you don't know the differences between hemorrhoids, fissures, and fistulas. And that’s okay! They are confusing because of the similarity between symptoms. That is why we will start by explaining the umbrella under which these conditions fall – Benign Anorectal Disease.

Benign Anorectal Disease

Benign anorectal disease is a collection of several conditions affecting the anus or rectal region. The onset of disease can be noticed through common symptoms like rectal bleeding, strained bowel movements, ulcers, and constipation.

The different conditions of benign anorectal disease can be both rare and common, and they all have different levels of severity. If you’re reading this article to understand a personal health problem, you might want to visit your local colorectal doctor for a proper diagnosis.

There are 5 common types of benign anorectal disease:

  1. Hemorrhoids
  2. Anal Fissures
  3. Anal Fistulas
  4. Pilonidal Sinus
  5. Anal Abscesses

We will explain the causes, symptoms, and common treatments of the first three.


Hemorrhoids or Piles are characterized by inflamed or swollen veins of the anus. The swollen veins can cause a person pain and discomfort. According to the World Journal of Surgical Procedures, hemorrhoids are considered one of the most common types of benign anorectal diseases and have a prevalence of up to 36.4% in the general population. They are divided into three main types based on the severity of the condition. But first, let’s look at the causes.

Hemorrhoids are often associated with strained bowel movements that exert pressure on the veins of the rectal region. Therefore, known triggers for Piles include chronic constipation, diarrhea, anal sex, and prolonged sitting. They are most commonly caused due to sitting on the toilet for long periods. Pregnancy is also a known contributor as the fetus can exert pressure on the veins inside the rectum.

The three main classes of hemorrhoids exhibit progressively worsening symptoms. The following are the three main categories:

  1. Internal Hemorrhoids: As the name suggests, these are located inside the rectum and are generally painless. Identifying these is an issue since one can't even see them. To a medical examiner, they would appear as swollen rubbery lumps inside the anus. Apparent identifiers for this class include irritation or itching around the anus. Internal hemorrhoids are prone to rupture and bleed. Although the bleeding does eventually stop, if internal hemorrhoids are left untreated, they become severely painful over time. In many cases, they also prolapse and have to be pushed inside, so a visit to the doctor is much recommended!
  2. External Hemorrhoids: Hemorrhoids on the outside of the rectum are distinctly different from their internal counterparts. The external anal region has more pain receptor nerve endings, making this condition severely painful. They can also sometimes develop boil-like skin tags, which can become infected.
  3. Thrombosed Hemorrhoids: Thrombosed hemorrhoids can give rise to many complications. The swollen veins we just discussed about can develop blood clots. These clots prevent blood from flowing. The increase in pressure inside the veins causes the hemorrhoids to burst. They are the most painful type of hemorrhoids with a lot of complications.

A warm Sitz bath is a time-honored therapy for alleviating pain caused by hemorrhoids. Other treatments include topical ointments, exercise, and a high-fiber diet. Although not always required, surgery is the best plan of action to prevent the recurrence of severely thrombosed hemorrhoids.

Anal Fissures

Anal fissures are tears in the mucosal lining of the anus. Although identifying fissures is easy because of the tears, they are extremely painful. Strenuous bowel movements, inflammatory bowel diseases, anal intercourse, and cirrhosis can contribute to anal trauma and are known triggers of fissures. According to the NHS, around 1 in every 10 individuals gets affected by anal fissures at some point in their life.

They cause immediate pain during or after passing stool. A characteristic symptom is the spasmodic movement of the anal sphincter, followed by throbbing pain. Their symptoms also worsen over time. Freshly developed fissures are called “Acute Fissures." They somewhat look like papercuts, meaning they are minor and superficial. If they're left untreated, they progress to "Chronic Fissures." These are more painful and appear as deep cuts in or around the anus.

Chronic fissures should not be treated at home. Of course, one can take warm baths to relax the sphincter and use ointments to alleviate the pain, but you should immediately seek medical assistance if you experience symptoms related to chronic fissures.

Chronic fissures can develop pus-filled boils that have to be drained by a doctor. By not seeking medical aid, you run the risk of contracting bacterial infections and the development of extra tissue growth (Hypertrophied Papilla) around the anus.


An anal fistula is a tunnel that forms under the skin and connects the anal canal to the skin of your buttocks. They form as a result of anal abscesses. Remember the pus-filled infections we just talked about? A fistula can form in reaction to an anal gland developing the infection.

People affected by Crohn's disease, chronic diarrhea, and Colitis are more likely to develop fistulas. Common symptoms include pain and swelling around the anus, fever, chills, fatigue, and drainage near the anus. Getting your abscess drained does not prevent you from developing a fistula. An ultrasound or Anoscopy can be scheduled for a proper diagnosis.

Surgery is the only option for treating fistulas. There are multiple surgical treatment options available these days. Some of the more common ones include Seton replacement, fistulotomy, and reconstructive surgery.

These were the three most common types of benign anorectal diseases. We hope this article helped you learn more about their symptoms, causes, and treatment options.