Anal Fissure vs Haemorrhoids: How to Tell
One question separates them, and getting it right saves weeks of the wrong treatment — plus the vicious circle that keeps fissures going.
Part of the Complete Haemorrhoids Guide.
Key fact: Does it hurt sharply when you pass a stool? A fissure does; haemorrhoids more often itch, ache or bleed painlessly. Both bleed bright red and both follow constipation, but the treatments differ — so treating the wrong one costs weeks.
One question separates them
Does it hurt sharply when you pass a stool? That single question does most of the diagnostic work. An anal fissure — a small tear in the lining of the anal canal — causes a sharp, tearing pain during a bowel movement, often followed by a burning ache that can last hours. Haemorrhoids are more often itchy and uncomfortable than sharply painful, and many bleed painlessly.
Both produce bright red blood, both follow constipation, and both are common. But they need different treatment, which is why getting this right saves weeks.
Fissure vs haemorrhoids
| Anal fissure | Haemorrhoids | |
|---|---|---|
| Pain | Sharp and tearing during a stool, then burning for minutes to hours | Often painless; aching, itching or a dragging sensation |
| Bleeding | Small amounts of bright red blood on paper or stool | Bright red, on paper, dripping, or coating the stool |
| Itching | Less typical | Common |
| Lump | None, though a skin tag can form at the edge of a chronic fissure | A lump or prolapse is common |
| Fear of opening bowels | Very characteristic — people put it off, which worsens constipation and the fissure | Less so |
| What it is | A tear in the lining of the anal canal | Swollen vascular cushions inside or at the anal margin |
The vicious circle worth naming: a fissure hurts, so people delay going, so the stool becomes harder, so the next one tears the fissure again. Breaking that circle with a soft stool is most of the treatment — it is not an optional extra.
How a fissure is treated
- Keep the stool soft — fluid, fibre and a laxative if needed. This is the core of treatment, not an add-on
- Warm shallow baths, particularly after a bowel movement, which relax the muscle and ease pain
- Pain relief — paracetamol or ibuprofen; avoid codeine, which constipates
- Topical treatment — healing creams are used for up to around eight weeks according to NHS guidance
- Muscle-relaxing ointments — where a fissure is not healing, treatments that relax the anal sphincter and improve blood flow are prescribed; headache is a recognised side effect of some of these
- Procedures — for fissures that persist despite treatment, injections to relax the muscle or a small operation are options
Most acute fissures heal with the measures above. NHS guidance is to see a GP if symptoms have not improved after about a week of self-treatment, or if they are getting worse.
How haemorrhoids differ in treatment
Haemorrhoids share the bowel-habit foundation but the topical treatments are different in purpose — soothing and anti-inflammatory rather than aimed at healing a tear and relaxing muscle. Steroid-containing preparations are used in short courses; see the creams compared. Persistent or higher-grade haemorrhoids are treated with procedures such as banding, covered on the main haemorrhoids page.
Using the wrong treatment wastes weeks. A soothing haemorrhoid cream will not heal a fissure, and a fissure treatment does nothing for a prolapsing haemorrhoid. If you have been treating one for a fortnight with no improvement, it is worth being examined rather than switching brands.
You can have both
It is entirely possible to have a fissure and haemorrhoids together — they share the same cause. An examination settles it quickly, and treatment can address both at once. Having one diagnosis does not mean the other has been excluded.
When it is neither
See a GP rather than self-treating if bleeding is painless and you are over 40, if there is a change in bowel habit lasting weeks, unexplained weight loss, tiredness suggesting anaemia, blood mixed through the stool, or black tarry stools. Fissures and piles are common, but neither explanation should be assumed — see rectal bleeding compared. Recurrent fissures, or fissures in unusual positions, can also point to inflammatory bowel disease or an infection and deserve assessment.
Prevention is the same for both, and it is mostly about the bowel: see how to stop piles coming back.
Frequently Asked Questions
How do I know if I have a fissure or piles?
Ask whether it hurts sharply when you pass a stool. A fissure causes sharp, tearing pain during a bowel movement followed by burning for minutes to hours, and people often start dreading going. Haemorrhoids are more often itchy, aching or painless, and a lump or prolapse is common. Both bleed bright red, so pain is the more useful distinguishing feature.
Can you have a fissure and piles at the same time?
Yes, and it is common, because they share the same cause — constipation and straining. Having one diagnosis does not exclude the other, and an examination settles it quickly. Treatment can address both together.
How long does an anal fissure take to heal?
Most acute fissures heal with soft stools, warm baths and pain relief, and NHS guidance is to see a GP if symptoms have not improved after about a week of self-treatment. Healing creams are used for up to around eight weeks, and fissures that persist beyond that may need muscle-relaxing treatment or a procedure.
Will haemorrhoid cream heal a fissure?
Not reliably. Soothing haemorrhoid preparations reduce itching and inflammation but are not aimed at healing a tear or relaxing the anal sphincter, which is what a stubborn fissure needs. If you have treated something for a fortnight without improvement, being examined is more useful than switching products.
Why does it hurt so much more than I expect?
The lining of the anal canal and the skin at the anal margin are richly supplied with nerves, so a small tear produces disproportionate pain, and the muscle then goes into spasm, which hurts further and reduces blood flow to the area. That spasm is why muscle-relaxing treatments are used for fissures that will not heal.
When is it neither a fissure nor piles?
When bleeding is painless in someone over 40, when there is a change in bowel habit lasting weeks, unexplained weight loss, tiredness suggesting anaemia, blood mixed through the stool, or black tarry stools. Recurrent fissures or fissures in unusual positions can also suggest inflammatory bowel disease or infection and need assessment.
References
- NHS. Piles (haemorrhoids). nhs.uk
- NHS. Anal fissure. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Haemorrhoids. cks.nice.org.uk
- National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12). nice.org.uk
- National Institute for Health and Care Excellence. Quantitative faecal immunochemical testing to guide referral for colorectal cancer in primary care (DG56). nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Rectal bleeding should never be assumed to be haemorrhoids without assessment. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.