Clinical review: Dr. Ramesh Babu V.C. — MBBS, MS, DPH, PGDM, FICS, FISCP, FIAGES, FMAS, FACRSI
Senior Proctologist & General Surgeon | 40+ Years of Clinical & Surgical Experience | Practising Since 1985
Patients frequently use the word “piles” to describe almost any problem around the anus. Pain, bleeding, swelling, itching or discharge may all be assumed to be piles. In reality, piles, anal fissures and anal fistulas are different conditions, and their treatment can be very different.
What are piles?
Piles, also called haemorrhoids, involve the normal vascular cushions of the anal canal becoming enlarged or symptomatic. Internal haemorrhoids are located inside the anal canal, while external haemorrhoids develop under the skin around the anus. FASCRS
Internal haemorrhoids commonly cause bright-red bleeding, particularly during or after a bowel movement. They may also prolapse, meaning tissue comes down through the anal opening. External haemorrhoids can cause swelling, itching or discomfort. If a blood clot develops inside an external haemorrhoid, it can become suddenly very painful. NIDDK
Not every patient with haemorrhoids needs a procedure or surgery. Dietary measures, improving bowel habits and office treatments may be sufficient for many people.
What is an anal fissure?
An anal fissure is a small tear in the lining of the anal canal. Its most characteristic symptom is sharp or severe pain during a bowel movement, often followed by burning or pain that can continue for minutes or hours afterwards. Fresh red blood may appear on the toilet paper or on the surface of the stool. FASCRS
Hard stools and constipation are common triggers, although diarrhoea can also contribute. The pain itself may cause the internal anal sphincter to tighten. Reduced blood flow to the injured area can then make healing more difficult, creating a cycle of pain, spasm and delayed healing. FASCRS
Many acute fissures heal with measures that keep stool soft and reduce trauma. Persistent or chronic fissures sometimes require prescription treatment, botulinum toxin or surgery.
What is an anal fistula?
An anal fistula is very different. It is an abnormal tunnel connecting the anal canal to the skin near the anus, commonly developing after an infected anal gland or perianal abscess. FASCRS
Typical symptoms include recurrent swelling, pain, irritation and drainage of pus or fluid through an opening near the anus. Symptoms may improve temporarily when the fistula drains and then return when the opening closes and infection builds again. FASCRS
Unlike uncomplicated piles or an acute fissure, a cryptoglandular anal fistula usually requires a procedural or surgical strategy. The aim is not only to close the fistula but also to protect the anal sphincter muscles responsible for bowel control. FASCRS
A simple way to remember the difference
Piles involve enlarged or symptomatic haemorrhoidal tissue.
Fissure means a tear.
Fistula means a tunnel or tract.
However, symptoms overlap. Bleeding can occur with both haemorrhoids and fissures, and pain may occur with fissures, thrombosed haemorrhoids, abscesses or fistulas. This is why symptoms alone cannot always establish the diagnosis.
When should you seek medical advice?
Rectal bleeding should not automatically be assumed to be piles. Other conditions, including inflammatory bowel disease, polyps and colorectal or anal cancer, can also cause bleeding. Persistent or recurrent bleeding deserves appropriate assessment. Mayo Clinic
Urgent medical assessment is particularly important if bleeding is heavy or continuous, or is accompanied by severe abdominal pain, fainting, dizziness, weakness or symptoms of shock. Fever together with increasing anal pain or swelling may suggest infection or an abscess. Mayo Clinic
The diagnosis matters more than the label
The correct question is therefore not simply, “Do I have piles?” It is: what is actually causing these symptoms?
A proctology consultation can include examination of the anal area and, when appropriate, a digital rectal examination or anoscopy. Additional testing is used selectively when symptoms or clinical findings suggest another condition. Cleveland Clinic
Ramesh Proctology, Hyderabad provides assessment of piles, fissures, fistulas and related anorectal symptoms.
Appointments: +91 89192 66510
