Is it a Hemorrhoids or Anal Fissure?

Woman in pain

Passing stool shouldn’t be a painful experience. However, most people will experience some discomfort or pain associated due to either hemorrhoids or anal fissure. These symptoms should abate after a few days (and should not take more than two weeks). In fact, if you dread going to the bathroom due to the ensuing pain, you should visit your doctor to rule out more serious conditions.

Painful stool, anal irritation, and blood in the stool are all symptoms of hemorrhoids. They are also symptoms of anal fissure. These conditions are not the same and often require different treatment methods.

Let’s deep dive into the main differences between anal fissures and hemorrhoids.

Anal Fissures

An anal fissure is a small tear in the skin surrounding the anus. They are usually small and go away on their own but are known for causing itching and bleeding in more serious cases.

There may be visible tears in the skin or anus compared to hemorrhoids where the veins get swollen up. Anal fissures are usually more painful than most hemorrhoids (definitely less painful than internal hemorrhoids). They are most commonly caused by the following:

  • Passing stool that is excessively large or hard
  • Excessive straining during bowler movements
  • Childbirth

Anal fissures can affect people of all ages, races, and gender. Sometimes it can be hard to tell the difference between hemorrhoids and anal fissures, but a doctor can provide you with the correct diagnosis - and the right kind of treatment.


Hemorrhoids are a common condition that will affect most people by the time they turn 50 years old. They are caused due to swollen veins around the anus which causes the surrounding tissue to expand outward around the rectal area. These swollen veins can be extremely painful, especially when passing stool. The effect can be particularly painful if the stool is dry or large.

These swollen veins can develop within the rectum or burgle outside the rectum. The symptoms will vary based on the exact location of the swelling.
The most typical signs of hemorrhoids are as follows:

  • Anal pain
  • Pain during bowel movements
  • Red blood on toilet tissue
  • Hard lump near the anal area

Although hemorrhoids and anal fissures are very similar, the latter is much more painful on account of skin tears.

Internal hemorrhoids are further classified into four grades:

  • Grade 1 hemorrhoid is painless but may result in red blood stools, but it does not protrude from the anal opening.
  • Grade 2 hemorrhoids protrude from the anal opening, especially when you pass a bowel movement, but they retract on their own.
  • Grade 3 hemorrhoids also protrude from the anal opening, but they only retract when physically pushed inside with a hand or object
  • Grad 4 is a permanently prolapsed hemorrhoid and may require surgery for treatment

The Main Difference Between Anal Fissures and Hemorrhoids

The biggest difference between the conditions is that anal fissures only become painful when the person is passing stool, while hemorrhoids can be excessively painful during the day. However, exceptions can be made to this rule.

A thorough examination is required to accurately determine if the condition is hemorrhoids, anal fissure, or something else. Another big difference is that most cases of anal fissure do not require surgical intervention and can be resolved with a stool softener and a high fiber diet. Hemorrhoids also require stool softeners but may require non-invasive procedures.

The best way to diagnose hemorrhoids or anal fissures is to see a doctor who will use an anoscopy to perform the examination. You may also be referred to a hemorrhoids specialist who will perform an internal examination called sigmoidoscopy to examine both the rectum and part of the colon.

It is worth noting that both hemorrhoids and anal fissures share common symptoms with a more serious infection such as cancer or an abscess. This is why it is not recommended to self-diagnose or self-treat the condition. Visit a doctor to rule out the other conditions.

Treatment Options: Hemorrhoids versus. Anal Fissures

Whether you have anal fissures or hemorrhoids, your doctor will try non-invasive treatment options and prioritize home remedies. Since both conditions have similar symptoms, their home remedy solutions are also very similar.
For example, you may be prescribed over-the-counter medications and creams for fissures to reduce muscle spasms. A cream such as Preparation H may be used to reduce the swelling of the hemorrhoids. The ointment can also be useful for numbing the pain, but it is only recommended for external use.

Similarly, to soothe the anal fissure, you may be asked to wipe the anal region with Witch hazel suppositories instead of regular, more abrasive toilet paper. These specially designed wipes have irritation-reducing ingredients to help with the symptoms.

Finally, your doctor will also recommend a warm bath or sitz bath for at least 20 minutes regularly for both anal fissures and hemorrhoids. By soaking the anal area with warm water for 20 minutes, you can improve blood flow to the area, relax the anal muscles, and clean the anus.

Surgery is almost always the last option. Most cases of anal fissure do not require surgery, but if the condition is severe enough and does not respond to home treatments, it may require surgery to promote healing and reduce the pain.

For hemorrhoids that take too long to cure, medical intervention may be necessary. These treatments include:

  • Hemorrhoidectomy - a surgical option to remove the hemorrhoids from the anus
  • Rubber band ligation - a nonsurgical option for less severe cases of hemorrhoids

Preventing Anal Fissures and Hemorrhoids

The key to preventing both conditions - or at least, reducing the risk of developing them - is a high-fiber diet in conjunction with lots of water to produce softer stools. This will reduce the need to strain and pass hard stool that could cause tears in the anal region. Below are a few tips to prevent the two conditions:
Add lots of fiber to your diet (such as vegetables, wheel grains, fruits, and legumes)

  • Drink lots of fluids (a hydrated person will produce clear or pale yellow urine)
  • Don’t strain to push bowel movements and avoid sitting in the toilet for too long
  • Don’t ignore the urge to have a bowel movement
  • Avoid vigorous wiping and use a softer tissue
  • Overweight individuals should lose weight
  • Thoroughly clear out any fecal matter from the anus
  • Exercise regularly built don’t lift heavy weights if you currently have hemorrhoids

If you believe that you or your loved one has hemorrhoids or anal fissures, make sure to visit a doctor to conduct an accurate diagnosis.