Hemorrhoids vs. Anal Fistula: Symptoms, Causes, and Treatment

Although similar symptoms may occur, hemorrhoids and fistula are different conditions. An anal fissure is a crack or tear in the anal tissue. A fistula is the formation of a tunnel or connection between two organs, or between an organ and the skin.

Fissures and fistulas can both cause pain and bleeding. However, they are treated differently, so it is important to distinguish them.

This article explains the difference between fissures and anal fistulas, and how to diagnose and treat each condition.

symptoms

Hemorrhoids and anal fistulas can have similar symptoms. Rectal bleeding and pain during bowel movements are symptoms of both conditions. However, other signs and symptoms of these conditions can help you differentiate between them.

Symptoms of anal fissure include:

• rectal bleeding
• Pain during defecation (Defecation disorder)
• Pain that lasts for a long time, sometimes hours after defecating
• Tenderness or discomfort in the anal area

Symptoms of perianal fistula include:

• Secretions from the fistula (including blood, mucus, and other body fluids)
• heat
• Incontinence (leaking of stool)
• Pain in the anal area (lower part)
• pain when going to the toilet

cause

Fistulas and fissures form in different ways and may be associated with other symptoms.

anal fissure

An anal fissure begins with a tear in the lining of the anus. It is thought that many acute fissures (lacerations that occur suddenly) may be caused by tension in the anal muscles.

However, especially in the case of long-term (chronic) cracks, possible causes of cracks include:

fistula

A fistula is a connection that shouldn’t exist between two internal organs or between an organ and the skin. The development of fistulas in the anal area usually begins with an infection. It begins as an abscess, a pocket of pus. In some cases, this can cause lumps or bumps under the skin in the anal area.

This abscess may eventually rupture and open, forming a passageway, or fistula, between the two organs. Fistulas may form between:

The root causes of fistulas include:

• cancer
• Crohn’s disease: a type of IBD that affects the entire digestive system
• infection
• Radiation therapy: may be used to treat some cancers
• Surgery: including intestinal resection (resection)

diagnosis

There is some overlap in the diagnostic methods for fissures and anal fistulas.

anal fissure

Fissures may be diagnosed by your health care provider after learning your symptoms and performing a physical exam, such as a digital rectal exam. Tell your health care provider if you experience bleeding, itching, or burning.

It is also important to determine the history of changes in bowel movements, such as diarrhea or constipation. The duration of symptoms (such as daily or several times a week) is important. Keeping a diary of your symptoms can be helpful when working with your health care provider.

In some cases, fissures may be found during a physical examination of the anal area. Other tests include:

• anoscopy: Gently insert the instrument into the anus to observe the anal tissue.
• colonoscopy: A flexible tube with a camera and light at the end is inserted through the rectum and into the colon.
• flexible sigmoidoscopy: This is similar to a colonoscopy, except that the tools are only used to view the first section of the large intestine, the sigmoid colon.
• proctoscopy: This is similar to an anoscopy, but allows you to look beyond the anus and further into the rectum.

fistula

Fistulas begin as abscesses, so diagnosing an abscess may be the first step. Your health care provider may find an abscess during an examination.

In some cases, a digital rectal examination is done. Immediately insert a gloved, lubricated finger into your rectum and check for any lumps.

Tests that can be used to diagnose fistulas in complex situations include:

process

Treatments for fissures and anal fistulas are different, so it is important to get an accurate diagnosis.

anal fissure

Anal fissures may heal naturally with several home treatments, including over-the-counter (OTC) medications and lifestyle changes. More complex or persistent cracks may require treatment with prescription drugs or surgery. Treatments include:

• diet: Your health care provider may recommend dietary changes, such as eating more foods containing fiber, taking fiber supplements, and drinking more water.
• Lifestyle: Health care providers recommend using a bidet instead of drying after defecating, using sitz baths (submerging the buttocks in a shallow pot of hot water), and staying on the toilet for long periods of time to reduce pain and discomfort. It may be recommended that you do not sit for hours.
• OTC: If constipation is causing your problem, the use of stool softeners may be recommended in addition to dietary and lifestyle changes.
• Prescription drugs: Topical medications include nitroglycerin, calcium channel blockers, and creams that can be applied directly to the anus to relieve pain. If topical medications are not effective, oral medications may be recommended and may include calcium channel blockers. Botox (botulinum toxin) injections are also an option.
• surgery: In some cases, if the fissure does not heal with more conservative methods, surgery may be used to treat the fissure and prevent it from recurring. The most common surgery is lateral internal sphincterotomy. Other types of fissure surgery include fissure excision or anal advancement flap surgery.

fistula

Abscesses are treated with antibiotics or drainage, fistulas with setons or drugs.

Treatment or drainage of abscesses: If an abscess is found before it forms into a fistula, it can be treated with antibiotics, which may prevent it from progressing to a fistula. Abscesses may also be treated by draining the pus that forms due to infection. Drainage is usually performed as an outpatient procedure.

Seton: A seton is a ring-shaped material that is passed through the fistula tube. Made of flexible materials such as silicone, nylon, silk, and surgical sutures. The seton keeps the fistula tunnel open, allowing pus and other fluid to drain and allowing the fistula to heal.

medicine: Prescription medications may be used to help heal abscesses and fistulas. Antibiotics help cure infections. If the fistula is associated with another disease, such as Crohn’s disease, treating the underlying disease with drugs may be part of the healing process.

surgery: Different types of surgery may be used to heal a fistula. This involves closing one side of the fistula tract or cleaning it completely open so it heals nicely.

In complicated cases, ostomy surgery may be necessary. In this procedure, part of the intestine is brought through the abdominal wall to create a stoma. Stool passes out of the body through the stoma and gets caught in a device placed on the abdomen. The appliance will be flushed down the toilet if necessary. In some cases, the stoma may be removed when the fistula has healed.

In situations where fistulas continue to develop, surgery to remove the rectum and anus may be done. In this case, the stoma becomes permanent.

prevention

It is not always possible to prevent cracks and fistulas. However, if you are at risk of developing any of these problems, or have had them in the past, there are some things to keep in mind.

crack

Constipation and diarrhea can cause fissures, so you should pay attention to your bowel habits and make sure your stools are soft and easy to pass. Exercise, eating fiber, staying hydrated, and avoiding straining at the toilet can help prevent hemorrhoids.

anal fistula

In some cases, fistulas may not be prevented. If you have Crohn’s disease, properly managing your condition may help prevent complications such as fistulas. If you are undergoing colorectal cancer treatment, such as radiation or surgery, talk to your health care provider about preventing fistulas.

General advice for maintaining good bowel habits includes not sitting on the toilet for too long or straining too much, drinking enough water, eating fiber, and getting regular exercise. It is included. See your health care provider regularly, especially if you think something is wrong with your bowel movements.

summary

Fissures and anal fistulas both affect the area in and around the anus, but the treatments are different. Therefore, it is important to consult your health care provider for diagnosis and treatment of rectal pain or bleeding.

A word from Berrywell

Symptoms associated with bowel movements can be upsetting and irritable. Many people worry that bleeding or pain could be cancer, but lacerated anal fistulas are more common, and anal fistulas can be associated with other conditions, such as Crohn’s disease.

Caring for your digestive health includes everything from diet and hydration to exercise and regular medical visits. Talking about bowel movements can be embarrassing, but health care providers know it’s nothing they haven’t heard before and are trained to handle any problem.