Difference Between Piles, Fissure and Fistula: Symptoms, Causes, and Treatment

Introduction

Many patients feel worried when they experience pain or bleeding near the anus. The three most common conditions affecting this area are piles (haemorrhoids), anal fissure, and anal fistula. While they may have similar symptoms, they are different conditions that require different treatments.

What Are Piles (Haemorrhoids)?

Piles are swollen veins in the lower part of the rectum or around the anus. They can be internal (inside the rectum) or external (under the skin around the anus).

Symptoms: Bleeding during bowel movements (bright red blood on toilet paper), itching or irritation, pain or discomfort, swelling around the anus, a lump near the anus.

Causes: Chronic constipation, straining during bowel movements, low-fibre diet, pregnancy, prolonged sitting or standing.

What Is an Anal Fissure?

An anal fissure is a small tear or cut in the lining of the anus. It is one of the most common causes of severe anal pain, especially during and after bowel movements.

Symptoms: Sharp, severe pain during bowel movements, bright red blood on stool or toilet paper, burning or itching after passing stools, visible crack in the skin around the anus.

Causes: Passing hard or large stools, chronic constipation or diarrhoea, childbirth, Crohn's disease.

What Is an Anal Fistula?

An anal fistula is an abnormal tunnel that forms between the inside of the anus and the skin outside. It usually develops after an anal abscess that has not healed properly.

Symptoms: Persistent pain and swelling near the anus, discharge of pus or blood from an opening near the anus, irritation of skin around the anus, fever if infection is present.

Causes: Previous anal abscess, Crohn's disease, tuberculosis, sexually transmitted infections, trauma or surgery.

Key Differences at a Glance

• Piles — swollen veins, bleeding without severe pain usually
• Fissure — tear in lining, severe pain especially during bowel movements
• Fistula — abnormal tunnel, discharge of pus, persistent pain

Treatment Options

Piles: Dietary changes and sitz baths for mild cases. Rubber band ligation, sclerotherapy, or laser surgery for moderate cases. Surgical haemorrhoidectomy for severe cases.

Fissure: High-fibre diet and stool softeners, topical ointments, Botox injection, lateral internal sphincterotomy (surgery) for chronic cases.

Fistula: Surgery is usually required. Options include fistulotomy, LIFT procedure, or laser treatment. Our laser surgery option offers faster recovery with minimal pain.