What is the Difference Between Piles, Fissures and Fistula?

By Dr. Amol Joshi in General & Minimal Access Surgery , Department of General Surgery

Apr 24 , 2023 | 5 min read


Piles, fissures, and fistulas are three common anorectal conditions that can cause discomfort, pain, and other symptoms. It's important to understand the differences between these conditions to seek the right treatment.

What are Piles: 

  • Piles, or hemorrhoids, are swollen veins in the anus or rectum. 
  • They can be internal or external and the symptoms of piles are itching, burning, and bleeding during bowel movements. 
  • Piles are often caused by constipation, diarrhea, obesity, pregnancy, anal intercourse, or lifting heavy weights. 
  • While not usually serious, they can be a nuisance and may require treatment in severe cases.

What are Fissures: 

  • Fissures are small tears or cuts in the anal lining. 
  • Symptoms of fissures include anal itching, pain, and bleeding. 
  • Fissures are caused by frequent or dry bowel movements, childbirth, anal infections, tumors, sexually transmitted diseases, anal trauma, or inflammatory bowel disease. 
  • Fissures may develop pus or bleed during bowel movements. 
  • Treatment for fissures includes increased fiber in the diet, lifestyle changes, topical medications, or surgery if necessary.

What is Fistula: 

  • Fistulas are tunnels that connect the anus to the skin around it. 
  • Fistulas are caused by an abscess or infection and can cause swelling, pain, itching, and discharge of blood or pus. 
  • Risk factors of fistula include trauma, tuberculosis, prolonged diarrhea, Crohn's disease, STDs, cancer, or radiation treatment. 
  • Fistulas usually require surgery to remove infected tissue and create a new pathway for waste to leave the body.

Symptoms of Piles, Fissures, and Fistulas: 

Piles Symptoms: 

  • Discomfort or pain in the anal region
  • Irritation, burning, or itching around the anus
  • Bleed in stool or anus after a bowel movement
  • Swelling or lump(s) around the anus
  • Mucus discharge after passing stool
  • A feeling of incomplete bowel evacuation
  • Prolapse of hemorrhoids (when internal hemorrhoids protrude outside the anus)
  • Itching and discomfort in the rectal area

Fissures Symptoms: 

  • Sharp and burning pain during bowel movement
  • Blood in stool 
  • Itching or irritation around the anus
  • A visible tear or crack in the skin around the anus
  • Muscle spasms in the anal sphincter (the muscle that controls the anus), can cause pain and make bowel movements difficult or painful
  • A feeling of incomplete bowel evacuation after a bowel movement

Fistulas Symptoms:

  • Pain in the anal area, especially during bowel movements
  • Itching or irritation around the anus
  • Discharge of pus or blood from the anus
  • Swelling or a lump around the anus
  • Recurrent abscesses around the anus
  • Fever or chills (in more severe cases)

It’s important to note that in the early stages, some of these conditions may not present any symptoms at all. Also, many of these symptoms may also be indicative of other, more serious conditions such as cancer. Hence it’s important to meet a general surgeon immediately after noticing these symptoms for an accurate diagnosis and treatment. 

Things to Avoid in Piles, Fissures, and Fistula

Things to Avoid in Piles

  • Avoid eating spicy foods
  • Avoid straining when passing stool
  • Increase fiber in the diet
  • Increase water intake
  • Avoid sitting on the toilet for a long time
  • Avoid lifting heavy weights
  • Exercise regularly

Things to Avoid in Fissures

  • Prevent constipation or diarrhea
  • Avoid eating spicy food
  • Exercise regularly
  • Increase intake of fiber and fluids
  • Keep the perianal area clean

Things to Avoid in Fistulas

  • Avoid straining when passing stool
  • Eat fiber-rich food
  • Increase fluid intake
  • Exercise regularly
  • Keep the area around the anus clean and dry

Quick Facts About Piles

  • Piles occur as a person grows older and affects over 50% of people who are 50 years or older.
  • Hemorrhoids are of 2 types – internal, which occur inside the anus and rectum, and external hemorrhoids which occur outside the anus.
  • Piles may be present for several years but remain unnoticed until bleeding occurs.
  • Most are not a serious condition and often, the symptoms of piles disappear without the need for treatment.

Quick Facts About Fissures

  • Anal fissures can cause itching, pain, and bleeding.
  • Although fissures can occur in people of all ages, they are more prevalent in newborns, older adults, and people with health conditions such as Crohn’s disease or HIV.
  • Anal fissures can be caused because of frequent, loose or dry, and hard bowel movements, childbirth, anal infections, tumors, sexually transmitted disease (STD), anal trauma, or inflammatory bowel disease (IBD).
  • If infected, fissures develop pus or it can even bleed during bowel movements.
  • Increasing the fiber in the diet, making lifestyle changes, drinking more water, and using topical medications can help to treat anal fissures.

Quick Facts About Fistulas:

  • Fistulas occur more commonly in men than women. People who previously had an anal abscess or IBS are also at a greater risk of developing fistulas.
  • Fistulas are caused due to many reasons including trauma, tuberculosis, prolonged diarrhea, Crohn’s disease, STDs, cancer or radiation for cancer treatment.
  • Anal fistulas can cause swelling, pain, itching around the anus, and discharge of blood or pus.
  • Fistulas typically require surgery, where the infected tissue is removed and a new pathway is created for the waste to be removed from the body.

Impact of Anal Disorders Such as Piles, Fissures, and Fistulas on the Body:

Piles, fissures, and fistulas may seem like common anorectal diseases, but their impact on the body and the lives of patients can be significant. If left untreated, they can lead to serious complications.

The symptoms of these conditions include pain, discomfort, itching, bleeding, and discharge of blood or pus during bowel movements. But the impact doesn't stop there. These anal diseases can also cause social and psychological impacts, making people feel embarrassed or self-conscious, which can affect their daily lives, work, and relationships.

It's crucial to seek immediate medical attention if you experience any of these symptoms. Early diagnosis and treatment can prevent complications and improve your quality of life. Don't let these conditions hold you back - take action today. 

Piles, Fissures and Fistula Complications: 

Piles Complications

  • If the hemorrhoids form a knot around the anal opening, then the condition can become serious, causing a lot of discomfort and pain.
  • If the blood supply is cut off to internal hemorrhoids, then it can become strangulated.
  • A clot may form in the piles, resulting in a thrombosed hemorrhoid.
  • Too much bleeding can cause anemia.

Fissures Complications

  • If the anal fissure doesn’t heal within 8 weeks, they are considered chronic and need further medical treatment.
  • Anal fissures are recurring.
  • The tear of the fissure may extend to the internal anal sphincter (muscles around the anus). A fissure that does not heal may require medications, even surgery.

Fistulas Complications

  • Fistulas need medical attention and cannot be treated with home remedies.
  • The treatment for fistulas is to eliminate infection using a combination of medications and surgery.
  • If not treated, fistulas can result in the formation of more fistulas, which can be difficult to cure.

The Best Treatment for Piles, Fissures, and Fistulas Include:

  • Having more fluids and fiber can help to make the stool softer and add more bulk, allowing it to pass more easily without causing any discomfort.
  • Applying an ice pack or a cold compress to the affected area can help to reduce pain.
  • A sitz bath (warm water with added salts) is an effective remedy for piles, fissures, and fistulas.
  • Drinking about 500 ml-600 ml of water on an empty stomach can stimulate the gastrocolic reflex, causing the colon to release stool easily.
  • If the condition is severe, it is recommended to consult a doctor, who may prescribe OTC over the counter) creams, ointments, or stool softeners.


Although piles, fissures, and fistulas are all anorectal diseases and occur in the anal area, they are distinct medical conditions that differ in terms of severity and treatment required.

By maintaining a healthy diet and healthy habits and seeking medical attention when required, these conditions can be prevented and managed effectively.