Hemorrhoids and anal fissures are two of the most common causes of pain and bleeding during bowel movements, and they are easy to mix up. They are different problems, though, and telling them apart helps you treat the right one. Here is a simple comparison of hemorrhoids versus anal fissures, and how each is handled.
The Quick Difference
Hemorrhoids are swollen blood vessels around the anus. An anal fissure is a small tear in the lining of the anus. Both can cause bright red bleeding, but the type of pain is the biggest clue: fissures cause a sharp, cutting pain during and after a bowel movement, while hemorrhoids more often cause itching, aching, or a lump, sometimes with less pain.
What Hemorrhoids Are
Hemorrhoids are swollen veins, similar to varicose veins, in and around the anus. Internal hemorrhoids often cause painless bright red bleeding and sometimes a feeling of fullness or a bulge. External ones can cause itching, swelling, and discomfort, and can become quite painful if a clot forms.
What an Anal Fissure Is
An anal fissure is a small crack in the sensitive lining of the anus, usually caused by passing a hard or large stool. Because the area has many nerve endings, even a small tear causes a sharp, burning pain that can last for hours after a bowel movement, along with a small amount of bright red blood.
How to Tell Them Apart
- Pain: a fissure causes sharp, knife-like pain during and after passing stool, hemorrhoids more often itch or ache, or cause painless bleeding.
- What you feel: hemorrhoids may create a soft lump or bulge, a fissure usually does not, though a small skin tag can form.
- Duration of pain: fissure pain can linger for hours, hemorrhoid discomfort is often more constant and dull.
They share a common root cause, constipation and straining, and a person can have both at once.
How Each Is Treated
The first steps overlap, because both improve when stools are soft and easy to pass:
- Both: more fiber and fluids (see our high-fiber diet), warm sitz baths, and not straining or delaying bowel movements.
- Hemorrhoids: if they persist, in-office treatments like rubber band ligation are quick and effective.
- Fissures: most heal with the steps above, and stubborn ones may need a prescription cream or a minor procedure.
When to See a Doctor
See a gastroenterologist if pain or bleeding is severe, keeps coming back, or does not improve within a couple of weeks. It is also important to make sure the bleeding is truly from a hemorrhoid or fissure and not another cause, especially if you are 45 or older or have a change in bowel habits. Our guide on blood in the stool explains when bleeding needs a closer look.
Talk to a Gastroenterologist in Mountainside, NJ
If your symptoms keep coming back or you are not sure what is causing them, Dr. Amber Khan can help. We see patients from across Union County and New Jersey.