Anal Fissure vs. Hemorrhoids: Symptoms, Causes, Treatment

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An anal fissure aa hemorrhoids there are other conditions. An anal fissure is when there is a crack or fissure in the anus. A hemorrhoid is when a vein in the anus becomes swollen. Both conditions can cause pain and bleeding. However, since they are treated differently, it is important to know how to distinguish them.

Learn more about the differences between an anal fissure and a hemorrhoid, including how they are diagnosed and treated.

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Some common symptoms of an anal fissure and hemorrhoids include blood on or in the stool and pain in the bowel movement. However, they can also cause other problems. Telling the difference between the two based on symptoms can be difficult, so a diagnosis from a healthcare provider is necessary.

Symptoms of an anal fissure may include:

  • Bleeding from the anus
  • Pain during bowel movements
  • Pain that lasts for hours after a bowel movement
  • Discomfort or tenderness in the anal area

The symptoms of hemorrhoids may include:

  • Bleeding from the anus
  • Sensation that there is an object in the anus
  • Itching in or around the anus
  • Pain in or around the anus
  • Pain during bowel movements
  • Rectal pain


When the anus is damaged, it can lead to the development of a fissure. Some of the possible causes of a crack include:

Hemorrhoids have some causes in common with fissures, but there are other reasons why hemorrhoids can develop. Some of the potential causes of hemorrhoids may include:

  • Traffic jam
  • Diarrhea
  • Heavy lifting, which may involve straining to lift something
  • Pregnancywhich can lead to strain on the muscles in the pelvic floor


An anal fissure or hemorrhoid can be diagnosed in several different ways.

First, the healthcare provider will take a medical history. They will ask about pain, bleeding, itching or burning, as well as other signs and symptoms such as constipation or diarrhea. It may help to keep a record of these symptoms in the days or weeks leading up to the visit to the health care provider.

A physical exam is usually performed as well. The healthcare provider will want to look at the anal area.

They can do a digital rectal examination. Then a greased, gloved finger is quickly inserted into the anus. A health care provider can feel if there are any internal hemorrhoids. Also, if the glove comes up with blood or other fluid, it can help with the diagnosis.

An anoscopy or proctoscopy is another test that can be done. Then a thin instrument with a light on the end is used to look into the rectum and anus. A biopsy, which is a small piece of tissue from the area, may also be taken and analyzed in a laboratory.

Before a physical exam or other test, you may want to ask about pain relief. Over-the-counter (OTC) oral pain relievers such as Tylenol (acetaminophen) or Advil/Motrin (ibuprofen) can help. There may also be local anesthetics that can be applied to the area to reduce discomfort during the examination.


There are several treatments that are used for anal fissure and hemorrhoids. However, others will work for one but not the other, so it’s important to get a diagnosis and understand which condition is present.


The crack can be treated through home remedieslifestyle changes, over-the-counter and prescription drugs, and surgery.

At home you can try a sitting bath (sitting in warm water), eating more fiber, drinking more water, and using a bidet after stool instead of wiping. Fiber supplements and stool softeners can also be used, but should be started after getting a recommendation from a health care provider.

Prescription medications may include nitroglycerin or pain-relieving creams applied directly to the anus. Oral medications may include calcium channel blockers, which may be used after topical treatments have failed to provide relief.

For fissures that become long-term and don’t improve with lifestyle changes, home remedies, or even medication, surgery may be the next step. Lateral internal sphincterotomy is the most common operation. It reduces tension in the internal anal sphincter muscle, allowing for more blood flow and better healing.

Other options include a fissurectomy (removal of damaged skin from around the fissure) or anal flap surgery (a flap of tissue is used to cover the area of ​​the fissure).


Hemorrhoids are most often treated with home remedies and by relieving whatever may be causing them, such as constipation or diarrhea. For more severe hemorrhoids that do not improve, medication and surgery may be prescribed.

To relieve pain and other symptoms, witch hazel pads (such as Tucks), barrier creams (such as those containing zinc oxide), or creams containing phenylephrine (such as preparation H) can be used at home.

Most hemorrhoids improve with conservative treatment that can be used at home. However, some will not improve or become complicated.

Then procedures can be used to reduce the size or remove the hemorrhoids. These may include tying with a rubber band (a rubber band is placed around the base of the hemorrhoid), sclerotherapy (a solution is injected into the hemorrhoid to shrink it), infrared photocoagulation (light creates heat to shrink the hemorrhoid), or electrocoagulation (an electric current tool is used to shrink the hemorrhoid).

Surgery can also be used for hemorrhoids that do not respond to other treatments. Hemorrhoid removal is called a hemorrhoidectomywhich is performed while the person is asleep under general anesthesia.

Stapled hemorrhoidopexy is another operation where prolapsed hemorrhoids (those that protrude from the anus) are stitched in place.

Comfort measures

Proper care of the anal area is also important. For example, gently wiping or using a bidet after a bowel movement, avoiding sitting on hard surfaces for too long, and going to the bathroom regularly can all be helpful.


The methods of preventing a fissure or hemorrhoid are similar in many ways, but there are some differences.


Preventing fissures involves making sure that the stool is neither too hard (constipation) nor too soft or runny (diarrhea) and that it is easily passed. In addition, it is important to get enough fiber in your diet and drink enough water for regular bowel movements. Straining to void should also be avoided.


Preventing constipation, diarrhea and straining on the toilet is also important for the prevention of hemorrhoids. Sitting on the toilet for too long can be a risk factor for hemorrhoids, so you should avoid it.

Lifting heavy objects or lifting weights can contribute to hemorrhoids. Learn how to lift heavy objects properly so you don’t strain yourself. For those susceptible for hemorrhoids, check with your healthcare provider about any restrictions.

Risk factors

Some other risk factors for anal problems include pregnancy, age, and medical conditions that cause constipation or diarrhea. For those at higher risk of fissures or hemorrhoids, it will be helpful to talk to your health care provider about how to avoid them.


Although there are many similarities in the causes, treatment and prevention of anal fissure and hemorrhoids, there are some clear differences. Both may present with blood in the stool and rectal pain. Both can be caused by constipation or diarrhea. An anal fissure can also be caused by trauma, infection, or inflammatory bowel disease.

Getting a diagnosis and treatment plan from your healthcare provider is important in treating and preventing complications.

Conservative home treatment can usually solve both problems, such as using a sitz bath and relieving constipation or diarrhea. Each condition has procedures or surgical techniques that can be used in cases that do not resolve with home treatment.

A word from Verywell

Fissures and hemorrhoids can be disturbing and embarrassing problems to deal with. Talking about bathroom problems in the anal area with a health care provider can be difficult. Still, it’s important to remember that they won’t be shocked or surprised.

Getting a diagnosis and getting the right treatment is important so that you feel better and that the problem doesn’t get worse or come back.

frequently asked Questions

  • When is it time to see a healthcare provider about hemorrhoids or fissures?

    Sometimes a hemorrhoid or fissure can get better at home with conservative treatment. However, if there is no change in a week or if symptoms worsen, seek help from a health care provider.

  • What is the best way to avoid hemorrhoids?

    Adding fiber to your diet, drinking enough water and exercising regularly can help avoid hemorrhoids. In addition, it is important to avoid spending too much time on the toilet. Reading or using your phone while defecating can lead to you spending too much time on the toilet.

  • Is rectal bleeding likely to be caused by hemorrhoids?

    Blood in or on the stool or toilet paper may be from hemorrhoids. But it’s important to know for sure. Bleeding can also occur from more serious causes and it is better to rule them out.

    A healthcare provider may be able to diagnose hemorrhoids quickly, usually with a brief look at the anal area.

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