Haemorrhoids and Anal Fissures: What’s the Difference?
Pain or bleeding when opening your bowels is common, and is most often caused by haemorrhoids or an anal fissure. Although they can feel similar, they are very different conditions, leaving many people unsure what they actually have. Not every anal symptom is from a haemorrhoid, so it is important to know what a haemorrhoid is and isn’t, and what other common anal symptoms can be caused by.
What are haemorrhoids?
Haemorrhoids (often called piles) are normal structures within the anal canal. They are cushions of blood vessels covered by skin that everyone has. They also have a function - we think they play a minor role in helping to maintain continence by contributing to the seal of the anus.
We usually only refer to haemorrhoids when they become enlarged and/or symptomatic. This is when most people seek the help of a doctor. Haemorrhoids can become problematic due to:
Straining on the toilet
Constipation
Pregnancy
Prolonged sitting
Common symptoms of haemorrhoids:
Bright red bleeding (usually painless)
Itching or irritation
A feeling of fullness or a lump around the anus
Lumps that protrude from your anus and require you to push them back up, especially after a bowel motion
Difficulty maintaining hygiene
A concern about the appearance of your anus
Occasionally, they can cause discomfort, especially if thrombosed (clotted)
What is an anal fissure?
An anal fissure is a small tear in the lining of the anus, usually caused by passing hard stools or trauma. Common symptoms of an anal fissure:
Sharp pain during or after bowel movements
Pain that can last minutes to hours, especially when sitting down
Small amounts of bright red blood, especially on the toilet paper
A burning or tearing sensation
What’s the main difference between haemorrhoids and fissures?
The key difference is pain.
Haemorrhoids commonly bleed, but are usually painless
Anal fissures are typically very painful, especially during bowel movements, but only cause very little bleeding.
While both can cause bleeding, the pattern of symptoms is often the best clue.
Can I have both at the same time?
Yes, it’s not uncommon to have both haemorrhoids and a fissure. This is because one of the common underlying causes is often constipation and straining.
What causes these conditions?
Both haemorrhoids and fissures are often related to bowel habits and pressure in the anal canal.
Common contributing factors include:
Constipation or hard stools
Straining on the toilet
Low fibre intake
Dehydration
Diarrhoea or irritation
Excessive wiping or aggressive hygiene
Addressing these underlying factors is an important part of treatment.
How are they treated?
Haemorrhoids
It is important to remember that haemorrhoids are a normal part of anatomy; everyone has them. Treatment is only required if they are causing symptoms, and you would like something done.
Before considering treatment, it is important to exclude more serious causes of symptoms. If bleeding is the main issue, this often involves a colonoscopy.
There are several treatment options, and the most appropriate approach depends on several factors:
Your main symptom (for example, bleeding versus prolapse or excess skin)
The severity (grade) of the haemorrhoids
Any previous treatments
Medical conditions and medications (including blood thinners — aspirin is usually acceptable)
Your individual circumstances, including time off work and recovery considerations
Addressing constipation and straining is an essential first step. Because haemorrhoidectomy (surgical removal of haemorrhoids) can be quite painful, operative treatment usually follows a stepwise approach, starting with simpler options first. Options include:
Rubber band ligation
Haemorrhoidal Artery Ligation with Recto-Anal Repair (HAL-RAR)
Formal haemorrhoidectomy
Dr Matt Marino can perform rubber band ligation during your consultation where appropriate, or arrange surgery if required. Treatment is tailored to your symptoms, findings, and individual needs.
Anal fissures
Effective treatment of anal fissures starts with addressing the underlying cause. Straining and constipation must be managed first. This usually involves adequate hydration, fibre (often with a supplement), and laxatives if needed, to ensure stools are soft and easy to pass.
Treatment then focuses on healing the tear. When a fissure occurs, the underlying sphincter muscle goes into spasm. This reduces blood flow to the area and prevents healing. Management is therefore aimed at relaxing the sphincter over a sustained period to allow the fissure to heal properly. For this reason, it is important to continue treatment for the full recommended duration, even if symptoms improve early.
Treatment options include:
Topical creams to relax the anal sphincter
Botulinum toxin (“Botox”) injections into the sphincter muscle
In selected cases, minor procedures or surgery, such as fissurectomy or lateral sphincterotomy
Dr Matt Marino can perform Botox injections during your consultation where appropriate, and will tailor treatment based on your symptoms and response to initial therapy.
Does this affect anal sex or intimacy?
These conditions are common and are not a reflection of sexual practices. However, their impact on intimacy is often overlooked or not addressed in standard care.
Haemorrhoids and anal fissures can have a significant impact on anal sex and intimacy, particularly for those who engage in receptive anal intercourse. The degree of impact depends on the type and severity of the condition.
Anal fissures are typically painful and often make penetration difficult or not possible until healing has occurred. Haemorrhoids may cause discomfort, bleeding, irritation, or concerns about appearance, all of which can affect confidence and sexual function.
If symptoms are present, it is important to allow appropriate healing before resuming anal activity. Returning too early can delay recovery or worsen symptoms. A structured, gradual return using adequate lubrication, minimising trauma, and in some cases incorporating anal dilation, can help achieve comfortable intercourse and reduce the risk of recurrence.
Persistent symptoms or difficulty returning to anal sex should be assessed properly. This is an area that requires specific understanding, not just of the condition itself, but of its functional impact.
Dr Matt Marino is a specialist colorectal surgeon with a focused interest in proctology and the effects of anorectal conditions on sexual function. His approach integrates clinical management with practical guidance on returning to anal intercourse, allowing treatment to be tailored not just to achieve healing, but to overall function and quality of life.
When should I see a doctor?
You should seek medical advice if you experience:
Ongoing pain or bleeding
Symptoms that are not improving
A lump or persistent discomfort
Uncertainty about the diagnosis
Even if symptoms seem mild, it’s important to confirm the cause.
Could it be something else?
While haemorrhoids and fissures are the most common causes, similar symptoms can occasionally be caused by other conditions.
If there is any uncertainty, further assessment may be needed to rule out other causes such as polyps, inflammatory bowel disease, or (less commonly) anal or bowel cancer.
Summary
Haemorrhoids and anal fissures are the most common causes of anal pain and bleeding
Haemorrhoids usually cause painless bleeding and swelling
Anal fissures typically cause sharp pain during and after bowel movements or intercourse
Both conditions are often linked to constipation and straining
Symptoms can overlap, so a proper assessment is important
Effective treatments are available for both conditions and should be tailored according to your symptoms, assessment and needs
How we can help
Haemorrhoids and anal fissures are both common and treatable causes of pain and bleeding, but they require different approaches to management. While symptoms can provide clues, a proper diagnosis is important to ensure the right treatment.
Dr Matt Marino provides expert assessment and management of haemorrhoids, anal fissures, and other colorectal conditions, including both non-surgical and surgical treatment options. He also offers specialised services, including bowel cancer screening and colonoscopy, and high-resolution anoscopy (HRA) for anal cancer screening where appropriate.
If you are experiencing symptoms or would like further advice, referrals are welcome via your GP. Contact us here or call on 0493 318 188 to book an appointment.
