Hemorrhoids and Anal Fissures

An anal fissure and hemorrhoids might sound similar, but they are actually two different conditions. An anal fissure is a tear or crack in the anus, while a hemorrhoid is when a vein in the anus becomes swollen.

Though both can cause pain and bleeding, it’s important to know the difference so you can get the right treatment. Learn more about the differences between anal fissures and hemorrhoids, including how they are diagnosed and treated.


Bleeding is one key way to tell that you may have either hemorrhoids or anal fissures. With either condition, you may notice blood on the toilet paper after a bowel movement. You could even spot some blood in the toilet bowl. Pain is one of those things that can be either a similarity or a difference.

Internal hemorrhoids generally don’t cause much discomfort. External hemorrhoids can be painful, though. anal fissures tend to be painful as well, particularly during a bowel movement and for some time afterward.

With fissures, you may experience muscle spasms along with your pain. This is unlikely to happen with a hemorrhoid. The location can help you determine whether you’re looking at a fissure or a hemorrhoid.

With a fissure, you might see a small tear in the anal region. A bump or skin tag may be nearby. External hemorrhoids can appear as small bumps or lumps. They might feel hard to the touch. Past hemorrhoids can leave behind skin tags.

Internal hemorrhoids can get worse over time and may eventually prolapse, or protrude from the anus. This is not something that anal fissures will do.

Risk Factors

Both hemorrhoids and anal fissures can be caused by bowel movement problems – constipation, in particular, is a common issue. Hemorrhoids develop because of the strain and pressure that constipation puts on your rectum. anal fissures may occur when you try to pass hard stools. Frequent diarrhea can also lead to both of these problems.

There are certain conditions that could develop during or after pregnancy, such as hemorrhoids or fissures, that didn’t exist before. For example, hemorrhoids may occur because of the extra weight from the baby putting pressure on the lower part of the body. Additionally, pushing during labor can cause hemorrhoids. As for anal fissures, they’re most likely to happen during delivery.

The age gap is one of the most significant risk factor differences between hemorrhoids and fissures. People are generally more susceptible to developing hemorrhoids as they age, whereas fissures are more common among young people, including infants. If you’re between the ages of 20 and 40, you’re more likely to experience a fissure than someone outside of that age bracket.


There are a few different ways that a healthcare provider can diagnose an anal fissure or hemorrhoid. First, they will take a medical history and ask about any pain, bleeding, itching, or burning that the patient has experienced.

They will also ask about other signs and symptoms, such as constipation or diarrhea. Keeping a record of these symptoms in the days or weeks leading up to an appointment can be helpful.

A physical exam is usually done as well in order to take a look at the anal area. The healthcare provider may do a digital rectal exam where a gloved, lubricated finger is quickly inserted into the anus. This allows the healthcare provider to feel for any internal hemorrhoids and also get a sample of any blood or fluid that may be present which can help with the diagnosis.

If your doctor thinks there may be something wrong with your anus or rectum, they may order an anoscopy or proctoscopy. This is a procedure where a thin, lighted tool is used to look inside your anus or rectum. Your doctor may also take a small tissue sample (biopsy) from the area for laboratory analysis.

If you’re worried about pain during an upcoming physical exam or another test, talk to your doctor about pain relief options. Over-the-counter (OTC) oral pain relievers like Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) can help. There are also local anesthetics that can be used on the area to numb the discomfort during an exam.


Your doctor can usually diagnose an external hemorrhoid or a fissure near the anal opening just by looking at it. Sometimes, though, the doctor needs to get a look at the inside of your rectum. A tool called an anoscope is useful for that.

After a diagnosis is confirmed, you and your doctor will go over your treatment options. For example, if your condition is mild, you may be able to treat it at home with some basic care.

To keep your bowel movements soft and promote healing, you can eat water, fiber-rich foods and take fiber supplements. Soaking in a warm tub or sitz bath can also provide pain relief. Over-the-counter pain relievers may also help.

If you need more intensive treatment, the solution will differ depending on which of the two conditions you have. For hemorrhoids, there are multiple surgical options, including rubber band ligation and laser coagulation to cut off the blood supply to the affected tissue. There’s also hemorrhoidectomy, which is a surgical excision procedure.

The goal of anal fissure surgery is to relax the muscles and ease tension so that the fissure can heal. Your doctor may first recommend using medication or injections to relax the muscle. Also, anal dilation could be used to stretch the rectum. If surgery is needed, it will involve cutting the anal sphincter muscle.

Key Takeaway

Although anal fissures and hemorrhoids share some similarities, such as blood in the stool or rectal pain, there are also some clear differences between the two. Different things can cause anal fissures and hemorrhoids, such as constipation or diarrhea, but an anal fissure may also be caused by trauma, infection, or inflammatory bowel disease.

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