What Is the Difference Between Hemorrhoids and Fissures?

Hemorrhoidal disease vs. anal fissures

Have you observed blood in your stool? Hemorrhoids and anal fissures are common types of benign anorectal diseases. Contrary to popular belief, these conditions do not tend to be dangerous, but experimenting with self-medication can prove disastrous if the cause or nature of the disease is unknown.

Therefore, consulting a doctor is essential for an accurate diagnosis. Keep reading this article to understand the difference between hemorrhoids and fissures.


Hemorrhoids are caused by the inflammation of hemorrhoidal veins and are widespread in the general U.S population, affecting 3 quarters of them before the age of 50. They refer to hemorrhoidal structures comprising veins, connective tissue, and smooth muscles that form the cushion guarding the anal sphincter. Trauma-induced pressure can cause these structures to swell up and cause pain and discomfort.

Inflammation and dilation of swollen veins can cause hemorrhoidal disease to develop. Well-known causes that contribute to increased pressure on the lower abdomen and rectum include the following factors:

  • Strained or forced bowel movements
  • Sitting for long periods of time
  • Physical strain and chronic constipation
  • Pregnancy and childbirth
  • Anal intercourse

Strenuous bowel movements are most commonly associated with hemorrhoidal disease since they put pressure on the anus, which can cause hemorrhoids to swell up. Hemorrhoids are classified into three categories depending on their location.

Internal Hemorrhoids

Internal hemorrhoids are located inside the rectal cavity. They are the most common among the three categories and usually painless; for this reason, they are not even identified unless the patient experiences rectal bleeding. Itching and irritation are some of the symptoms associated with internal hemorrhoids.

Although painless, internal hemorrhoids can rupture from increased pressure. Medical treatment is usually not required unless pain management is needed. They can develop into chronic forms of hemorrhoids. Internal hemorrhoids are divided into 4 classes based on the pain and severity of the hemorrhoidal structures.

Classes I and II of internal hemorrhoids are considered to be less dangerous. Usual symptoms include itching and irritation, while blood is observed only in some cases. Classes III and IV cause severe pain and discomfort. They can also cause hemorrhoids to prolapse and protrude out of the anus. A prolapsed Class IV hemorrhoid cannot be pushed back inside the anus; therefore, the affected person requires immediate medical assistance.

External Hemorrhoids

Swollen hemorrhoids on the external anal region are classified as external hemorrhoids. They tend to be painful since the skin outside the anus has numerous pain receptors. External hemorrhoids can cause the skin to stretch and split. This can cause bleeding and the formation of boil-like skin tags that can contract bacterial infections and develop pockets of pus. Although easier to identify, external hemorrhoids cause more pain and discomfort than internal hemorrhoids.

Thrombosed Hemorrhoids

Chronic hemorrhoidal disease can cause blood to pool inside the swollen hemorrhoids. Increased blood flow and a combination of other factors can cause clots to develop inside hemorrhoidal veins. Blood clots cause painful red-colored thrombosed hemorrhoids to form. These hemorrhoids cause severe discomfort and are prone to rupture. Sitting down and passing bowel movements become extremely painful. Still, they are not life-threatening and go away on their own in most cases. A thrombectomy or hemorrhoidectomy can permanently remove the thrombosed hemorrhoid and clotted veins to prevent any chance of recurrence.

Other hemorrhoids treatments include the use of topical ointments, painkillers, Sitz baths, and lifestyle changes for softening stool to reduce abdominal stress.

Anal fissures

Unlike hemorrhoidal disease, anal fissures are always painful. Fissures are not associated with hemorrhoidal structures and directly affect the skin lining the rectal canal; they are caused by tears and laceration of the sensitive mucosal lining of the anus. Research indicates almost all anal fissures occur along the midline of the anus, and approximately 235,000 new cases are reported every year.


People suffering from inflammatory bowel diseases like Crohn's disease are more likely to develop anal fissures. Hard, dry bowel movements and anal sex are among the leading causes of anal fissures since they cause trauma to the inner lining of the anus. Causes common to both hemorrhoids and anal fissures are listed below:

  • Diarrhea
  • Low-fiber diet
  • Strenuous bowel movements
  • Pregnancy and childbirth
  • Colorectal cancer and previous history of anorectal diseases

Like hemorrhoids, anal fissures are divided into different types based on the duration of symptoms, etiology, and location of occurrence.

Freshly developed anal fissures are classified as acute fissures and do not cause much discomfort. When left untreated, they develop into chronic fissures, which are extremely painful and require medical attention. Fissures located along the back of the rectal region are called posterior fissures, while those on the front are called anterior fissures. Lastly, they are divided into primary and secondary fissures based on etiology.


Unlike hemorrhoidal disease, all types of fissures are painful from the beginning. They cause severe throbbing pain after a bowel movement and cause spasmodic action of the anal sphincter muscle. This symptom is a unique characteristic of anal fissures. Pain can also immediately be noticed during a bowel movement and can last several minutes or hours.

Similar to hemorrhoidal disease, rectal bleeding is also a symptom of fissures. Bright red blood is commonly observed in the stool. Discomfort during urination or inability to empty the bladder are also signs of the disease.

Anal fissures also exhibit superficial cuts or deep lacerations on the skin around the anus. Foul-smelling discharge and extra tissue growth (hypertrophied papilla) are specific symptoms of chronic fissures. Patients often complain about constipation and sharp burning pain that subsides in-between bowel movements.

We hope this article helped you understand the difference between hemorrhoids and fissures. Since they share a lot of symptoms, it is vital to consult a colorectal doctor for an accurate diagnosis. Doctors will help you manage pain-related symptoms and devise an appropriate treatment plan accordingly.