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

October 18, 2022

Author: Tanvi Lodhia, Doctor of Pharmacy

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


Hemorrhoids and anal fissures often have similar symptoms since they both occur in the rectum, but they arise due to a different injury.



Swollen, inflamed veins due to increased pressure around the anus or lower rectum

Tears or open sores (ulcers) that develop in the lining of the large intestine, near the anus


·         Mild – Moderate Pain

·         Itching

·         Blood in the stool is usually found on the toilet paper after wiping

·         Moderate – Severe sharp, noticeable pain followed by a deep burning pain that may last several hours

·         Bright red blood in the stool usually present separately in the toilet


Constipation, Prolonged Straining, Certain Foods & Drinks



Increase Fiber Intake, Hydration, Toilet Hygiene, Exercise & Stool Softeners


Laxatives, Painkilling Ointment, Sitz Bath, Witch Hazel, Bioflavonoids, Decongestants

Laxatives, Painkilling ointment, surgery,


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.

anatomy of the anal canal rectum anus fissure hemorrhoids polyp proctitis diverticulitis stalk cancer

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


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



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.


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