Is it Hemorrhoids or Anal Fissure? What is the difference and how are they treated?

WRITTEN BY: TANVI LODHIA, DOCTOR OF PHARMACY. 

Hemorrhoids and anal fissures often have similar symptoms since they both occur in the rectum. However, they arise from different underlying causes.

What are Anal Fissures and why do they occur?

Let’s do a quick anatomy review before we learn more about anal fissures. Food starts to move through the GI tract once it enters your mouth. It then goes through your esophagus and stomach. In your stomach, the food mixes with the digestive juices to break it down into smaller pieces. The churned food moves into the small intestine for the absorption of water and nutrients. The waste products are pushed into the large intestine and rectum until the body is ready to push the stool out of the anus.

Sometimes the stool moves too slowly through the GI tract which causes it to become hard and dry. These hard stools become painful to push out and can lead to constipation. Unfortunately, fissures occur usually due to constipation. It is quite literally when a particularly large poop tears the lining of the anus. This is why patients usually complain of having noticeable sharp pain in the anus.

Click here to learn more about hemorrhoids!

It is important to note there are also other possible causes of anal fissures:

• Pregnancy & Childbirth
• Sexually Transmitted Infections (STIs)
• Persistent Diarrhea
• Inflammatory Bowel Disease (IBD) like Chron’s and Ulcerative Colitis

Prevention

Since hemorrhoids and anal fissures are mostly caused by constipation, physicians usually recommend the same prevention strategies

• Eat plenty of high-fibrous foods such as fruits, vegetables, and nuts
• Maintain adequate hydration by drinking at least 8 x 8 oz glasses of water daily
• Perform good toilet hygiene i.e., when you have the urge to defecate… go!
• Exercise and/or walk daily for 30–60 min, 3 to 5 times per week
• Stool Softeners can be added if non-pharmacological options do not work

Treatment

The key treatments for anal fissures are laxatives and topical anesthetics (painkilling ointment). Your physician may recommend other medication as well.

• Topical Anesthetics such as lidocaine – will help soothe the pain from anal fissures. You may have used lidocaine in the past if you had any dental work done or needed minor surgery. However, this type of lidocaine is applied topically to the rectum.
• Laxatives –help increase stool motility allowing strain-free bowel movements and releasing constipation. There are many different types of laxatives but most commonly your physician will want you to take bulk-forming laxatives to help increase moisture to the hard poo that is awaiting to be released in the anus.
• Topical Nitroglycerin– if you had or know someone who has angina, you are no stranger to nitroglycerin. Like tablets, the ointment dilates the vessels in the anus to improve blood flow and reduces the pressure in the canal to increase healing time.
• Topical calcium channel blockers – like nitroglycerin, calcium channel blockers are primarily used for heart conditions like high blood pressure and arrhythmias. However, in an ointment form, they can be quite useful for relaxing the muscles in the anus to reduce pressure and provide a better blood supply.

Key Takeaways

• Hemorrhoids and Anal Fissures both occur in the rectum and can be quite painful
• If pain is a concern for you, speak to your physician about treatment options including lidocaine ointment.
• Preventing constipation is critical to decreasing your chances of having hemorrhoids or fissures.

Tips for Managing Symptoms at Home

Whether you're dealing with hemorrhoids or an anal fissure, at-home care can play a big role in easing discomfort and supporting healing. Simple lifestyle adjustments are often the first step in both prevention and recovery.

Start by increasing your fiber intake through fruits, vegetables, and whole grains. Fiber softens stool and promotes regular bowel movements, which reduces straining—one of the most common triggers for both conditions. Drinking plenty of water throughout the day also helps with this.

Warm sitz baths—soaking the anal area in warm water for 10–15 minutes several times a day—can soothe irritation and promote healing. This is particularly helpful for relieving inflammation caused by hemorrhoids or the pain of a fissure.

For external hemorrhoids, over-the-counter creams or ointments containing hydrocortisone, witch hazel, or lidocaine can offer temporary relief from itching and swelling. If you suspect an anal fissure, applying a gentle healing ointment like petroleum jelly may reduce pain during bowel movements.

If symptoms last more than a few weeks, or if you notice persistent bleeding, consult your doctor. More advanced treatments—such as prescription creams or minor procedures—might be necessary.

Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging. You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should always consult with a healthcare professional before starting any diet, exercise, or supplementation program, before taking any medication, or if you have or suspect you might have a health problem. Statements regarding dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease or health condition