Difference between piles and fissure

What is Piles ?

Hemorrhoids or piles are a normal part of the anatomy and their presence per se does not imply a disease state.

They are caused by enlarged blood vessels that cause small swellings, either inside or outside your rectum. The blood vessels become enlarged when subjected to pressure, for example, when straining to pass stools when constipated or during childbirth. Hemorrhoids are more likely to occur if you are overweight, constipated or elderly. Hemorrhoids are usually a minor and temporary inconvenience. However, if symptoms are persistent piles specialist doctor should be able to offer advice and medication to help.

piles symptoms

Symptoms of Piles

  • Swelling and irritation, in or around your rectum.

  • Fresh, bright red blood on the toilet paper is a sign of internal hemorrhoid.

  • External hemorrhoids can bleed, usually when rubbed by toilet paper or tight-fitting underwear.

  • A thrombosed pile may feel like a painful lump.

When to consult Gastroenterologist ?

In most cases, hemorrhoids / piles are nothing more than a temporary problem. If you notice dark blood mixed with your stools, experience pain or suffer excessive irritation or mucus leakage, you should see experienced Gastroenterologist.

Hemorrhoids / Piles treatment in India ?

Many times piles does not require any treatment, within a few days it get better. During suffering piles issue some simple treatment such as bathing in warm water or using local ointment will remove some of discomfort.  Endoscopic treatment includes Injection therapy (Sclerotherapy), Band ligation, Infra-red coagulation. Surgical removal might be warranted in the case of recurring or very bothersome hemorrhoids.

Prevention of Piles

  • Avoid constipation by eating plenty of fiber, including fresh fruit, vegetables, whole wheat bread, and cereals and drink plenty of fluids
  • Exercise regularly. This will also help to prevent constipation and ease the pressure on the hemorrhoids.
  • Avoid using hard toilet paper, use soft paper or medicated wipes instead.
  • Reduce discomfort by washing gently with warm water or sitting in a tub of warm water for 10 minutes several times a day. Using an ice pack can also help reduce pain and swelling.
  • Do not scratch the area as this will make it more painful and uncomfortable.
  • Wear loose-fitting underwear made from natural materials such as cotton.
  • Avoid obesity.

What is Fissures ?

Fissures are common in the general population but some time fissure can be cause of pain and bleeding, such as piles. Basically, an anal fissure is a liner tear near the anal opening. Anal fissure normally occurs after passage of hard, large bowel movement, but in some cases, it can occur with diarrhea, IBD, or it can be a unknown reason.

Anal fissures have equal gender distribution and it can occur at any age of population.   Most (85-90%) fissures occur in the posterior (back) midline of the anus with about 10-15% occurring in the anterior (front) midline.  A small number of patients may actually have fissures in both the front and the back locations.  Fissures located elsewhere (off to the side) should raise suspicion for other diseases and will need to be examined further.


fissure treatment in India

Symptoms of Fissures

The typical symptoms include pain and bleeding with bowel movements.  Patients note severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours.

Patients may notice bright red blood from the anus that can be seen on the toilet paper or on the stool.  Between bowel movements, patients with anal fissures are often relatively symptom-free.  Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.

Causes of Fissures

Main cause of fissures is hard, dry bowel movement is normally responsible but some time diarrhea can also be caused of it. Fissures are usually occurred by trauma to inner lining of the anus. The inciting trauma to the anus produces severe anal pain, resulting in anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure. Further bowel activities result in more agony, more anal shudder, diminished blood flow to the area, and the cycle is spread. Treatment strategies are aimed at interrupting this cycle to promote healing of the fissure.

Less common causes of fissures include inflammatory conditions and certain anal infections or tumors, such as Crohn’s disease, ulcerative colitis, syphilis, tuberculosis, leukemia, HIV/AIDS, or anal cancer.  These diseases cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment.

Fissures treatment in India

The majority of anal fissures do not require surgery.

The most common treatment for an acute anal fissure consists of making one’s stool more formed and bulky. With a diet high in fiber as well as utilizing over-the-counter fiber supplementation (totaling 25-35 grams of fiber/day).  Stool softeners and increasing water intake may be necessary to promote soft bowel movements and aid in the healing process.

Topical anesthetics, such as lidocaine, can be used for anal pain, and warm tub baths (sitz baths) for 10-20 minutes several times a day (especially after bowel movements) are soothing and promote relaxation of the anal muscles, helping the healing process.   These non-operative measures will help achieve resolution of pain and bleeding and, potentially, heal greater than half of the acute fissures with virtually no side effects.

Chronic fissures are generally more difficult to treat, and your doctor may advise surgical treatment for fissures either as an initial treatment or following attempts at medical management.

  • Medications
  • Nitroglycerin Ointment
  • Calcium Channel Blockers
  • Non-healing fissures

A fissure that fails to respond to conservative measures should be re-examined.  Persistent hard or loose bowel movements, scarring, or spasm of the internal anal muscle all contribute to delayed healing.  Other medical problems such as inflammatory bowel disease (Crohn’s disease), infections, or anal tumors can cause symptoms similar to anal fissures.  Patients suffering from persistent anal pain should be examined to exclude these diseases. This may include a colonoscopy and an exam in the operating room under anesthesia with biopsies and tissue cultures.

Role of surgery in treatment of fissures

Surgical options for treating anal fissure include Botulinum toxin (Botox®) injection into the anal sphincter and surgical division of a portion of the internal anal sphincter (lateral internal sphincterotomy).  Both of these are performed typically as outpatient procedures.  The goal of these surgical options is to promote relaxation of the anal sphincter, thereby decreasing anal pain and spasm, allowing the fissure to heal.  If a sentinel pile is present, it may be removed to promote healing of the fissure.

All surgical procedures carry some risk and both Botox® injection and sphincterotomy can rarely interfere with one’s ability to control gas and stool. Your colon and rectal surgeon will discuss these risks with you to determine the appropriate piles and fissures treatment in India for your particular situation.

What are the common treatments for piles in India?

Piles in India are treated using methods like Sclerotherapy, Band Ligation, and Infra-red Coagulation. Surgical removal may be considered for severe cases.

How can I prevent piles?

To prevent piles, maintain a high-fiber diet, stay hydrated, exercise regularly, and avoid straining during bowel movements. Seek advice from Gastroenterologist in India if needed.

What is the approach to fissure treatment in India?

Fissure treatment in India involves dietary changes, stool softeners, and sitz baths. Surgical options like Botulinum toxin injection or sphincterotomy may be considered for chronic fissure cases.

Where can I find expert treatment for piles in India?

Look for specialized gastroenterologists in India who offer advanced piles treatment options like Sclerotherapy and Band Ligation.

Are non-surgical options available for fissure treatment in India?

Yes, non-surgical approaches such as dietary modifications, topical anesthetics, and warm baths are commonly used for fissure treatment in India.

What should I do if I experience persistent pain after piles or fissure treatment in India?

If pain persists post-treatment, consult your doctor for a re-evaluation. It might be necessary to explore other causes or consider additional interventions.