Difference between Piles, Fissure and Fistula

Table of content

• The anal or the anorectal region

• What are piles or hemorrhoids?

• What are anal fissures?

• What are anal fistula?

• Difference between piles and fissure and fistula

• What tests do I need to examine piles, fissure and fistula?

• Treatment options for anal disorders

• How to prevent piles, fissure and fistula?

• Home remedies for pilese fissure and fistula

• Take-home message

• FAQ on Difference between Piles, Fissure and Fistula

Introduction

Anal disorders, also known as anorectal disorders are quite common. It is important to have a basic understanding of the structure of the anal region to get a grasp over the different anal disorders. 

The anal or the anorectal region

• The anus is the opening of the large intestine to the outside. Rectum is the terminal portion of the large intestine. Together, it is called anorectal region as few pathologies of both the regions occur together. This region is about 4-5 cm long and is divided into parts, each part having its own blood supply and nerve supply.

• However there are a few disorders that are exclusive to the anal region. These include: Piles or hemorrhoids, Anal Fissures and Anal Fistula. These anal disorders are actually very common in occurrence and cause great disruptions in the day-to-day lives of the people affected.

• Further cancer of the anal region and the rectum can also occur. Colorectal cancer involving the rectum and the preceding part of the large intestine (colon) is also very common in occurrence.

What are piles or hemorrhoids?

Piles are enlarged or dilated blood vessels ( veins in specific) that are felt as a knots or lumps around the anal opening. These vessels normally cannot be felt, but when they become engorged as in Piles, they can be felt by the patient.

Types of Piles

• There are two different types of hemorrhoids - External and internal. The names do not always suggest if they are present outside the anus or inside. They are classified based on the site where they arise in the anal region. Internal piles arise in the proximal portion of the anus, whereas external ones arise closer to the outside opening. Internal piles can enlarge and appear outside and external piles can stay inside and vice versa. 

• Hemorrhoids can also be graded based on their size and severity of complaints.

How does it look?

Whenever you hear the word ‘piles’, do not always imagine a scary reddish blue lump. In the initial stages, the piles look like a discolored rubbery mass that is soft to touch.

6 Causes of piles or hemorrhoids

Since piles are caused by the enlargement of veins, all the factors that could increase the pressure over and within the veins could cause them:

1. Straining at stools, due to constipation.

2. Passing hard stools.

3. Persistent coughing, as in chronic smokers or Tb patients.

4. Pregnancy and childbirth, where the enlarged uterus is compressing the distal veins.

5. Lifting heavy objects frequently.

6. Old age, which causes weakness of the pelvic floor muscles.

7 Symptoms of piles

In the early stages, piles are mostly asymptomatic and do not cause any trouble. However as they progress, they can cause complaints like:

1. Blood in stools which drips or stains the toilet paper.

2. A mucus like discharge that stains underwear.

3. Excess itching around the anus.

4. Pain and discomfort during defecation.

5. Pain during prolonged sitting.

6. A lump felt around the anus.

7. Tiredness and weakness if the patient becomes anemic due to prolonged bleeding.

Even though these symptoms can be seen in piles, they are not exclusive here. A similar picture can be seen also in other anal disorders like fissures or fistulae. Hence let’s talk about the difference between piles and fissure and fistula.

What are anal fissures?

An anal fissure is a small tear in the lining of the anal canal. This is an extremely painful condition and can bleed rarely.

Types of fissures

• Fissures can either be acute or chronic. Acute fissures are recently developed ones, usually due to injury and can easily be treated by simple home remedies and painkillers.

• Chronic fissures are long-standing ones which usually occur as a result of an underlying medical condition. These require medical or surgical assistance to heal.

How do they look?

Anal fissures are visible as a small tear during a physical examination by the surgeon. However, usually the patient will not be able to visualize or feel it.

Symptoms of fissures

Again, the clinical picture of anal fissures can resemble that of hemorrhoids.

What is a sentinel tag?

• Sentinel skin tags or anal skin tags are excess folds of skin that are seen clumped around the anal opening, usually seen in relation to an anal fissure. These can be confused with either external piles or with warts caused by papilloma viral infections.

• These tags are benign. When a patient has a long-standing fissure, the skin around the anus becomes very inflamed and forms a tag. These tags can worsen with constant itching or scratching around the anus.

• They could be very painful if associated with fissures and could cause a foul smelling discharge. Once the underlying fissure is treated, the tags gradually reduce in size.

Causes of fissures

• Most of the causes are the same as that of Hemorrhoids.

• However in addition to the above, practice of anal sex and insertion of foreign objects and sex toys into the anus can increase the risk of developing painful fissures.

• Further, any underlying medical disorders like inflammatory bowel disease, HIV, tuberculosis of the intestine, cancers etc. can also increase the risk of fissures.

What are anal fistula?

Anal Fistula is a tunnel or a connection between the anal canal and the skin surrounding the anus.

How are anal fistula formed?

• There are plenty of mucus glands in and around the anus. These are meant for keeping the area moist and protected. Sometimes, if the openings of these glands get blocked, they are not able to drain their secretions, thereby developing into abscesses. If they rupture, it creates a tunnel between the anal canal and the outside skin. However this rupturing is rare.

• Now these infected, foul smelling secretions start oozing out of this tunnel.

• Also sometimes fistulae could develop because of radiation therapy and surgeries or even during pregnancy.

9 causes of anal fistula?

All those factors that can lead to blockade and infection of anal glands and cause anal abscesses can cause anal fistulae. These include:

1. Inflammatory bowel disorders like Crohn’s disease.

2. Sexually transmitted infections.

3. Tuberculosis of the intestine.

4. Diverticulitis (A condition where small outpouchings would be formed in the intestinal wall ).

5. Cancer.

In addition to those, other factors that could lead to a fistula include:

6. Trauma and injury.

7. Surgical injuries.

8. Injury to mother’s anus during childbirth.

9. Radiation when given as cancer therapy.

5 Symptoms of anal fistula

1. Pain & swelling around anus.

2. Severe irritation and itching.

3. Bloodstained foul smelling discharge coming from a small opening on the skin. This opening is actually connected via the fistula tunnel to the anal canal. So even stool matter could leak through this opening. This could cause discomfort and embarrassment to the patient.

4. Pain during defecation.

5. Weakness and fever due to the infection.

Difference between piles, fissure and fistula

The crucial difference between Piles and Fistula and Fissure is:

Piles also known as hemorrhoids are swollen blood vessels in the anal canal that cause painless rectal bleeding when you go to stool.

Fissures are tears or cracks in the skin of the anal canal that are painful and bleeding stools.

Fistula is an abnormal connection between two hollow spaces like blood vessels and intestines or two epithelial surfaces. 

What is the difference between fissure and piles

Even though the presentation can be similar between them, there are a few differences between fissure and piles:

1. Piles are swollen vessels whereas fissures are a tear

2. Piles are usually asymptomatic and painless, but fissures are extremely painful right from the beginning. This pain caused by fissures persists for a long time after defecation.

Now let’s talk about anal fistula and the difference between fissure and fistula and the difference between fistula and piles.

What is the difference between fissure and fistula?

Fissure is a tear in the inner lining of the anal canal whereas fistula is a cross-connection between the inner lining of the anal canal and the outer skin. This is the main difference between fissure and fistula.

What is the difference between fistula and piles?

Piles are caused due to engorged veins and do not have an infective origin, unlike fissures. Further piles can be silent for a long time.  But fistula itself is a complication of a long-standing abscess. So fistulae present with severe pain and oozing discharge right from the beginning. This is the difference between fistula and piles.

What tests do I need to examine piles, fissure and fistula?

Whenever you experience any symptoms of anal disorders, it’s important to meet with a surgeon because all of them are treatable and treatment could improve your quality of life. Your surgeon may one or many of the following tests to arrive at a diagnosis:

1. Clinical examination

Per-rectal examination is done by the surgeon after application of topical anesthetic cream and lubricant where he/she inserts a finger into your anus to feel for any piles or lumps.

2. Proctoscopy examination

This is a per-rectal examination done after insertion of a proctoscope, a speculum-like instrument that helps in visualizing the lowermost 10-13 cm of the large intestine. This may help to detect any fissures or the inner opening of a fistula as well.

These examinations may sound terrifying and painful, but they are important to arrive at a diagnosis to help you get better. Further they are done very gently and under topical anesthetic creams that could numb the pain completely. However during any point in the examination if you feel any pain or discomfort, it is very important to convey the same to the surgeon and they’ll immediately stop.

3. Sometimes you may be advised an ultrasound scan or an MRI scan to trace the track of the fistula tunnel.

4. Usually if a skin tag is found, this could be a pointer for an underlying fissure which is an extremely painful condition. So the surgeon won’t perform a per-rectal examination. However if needed, he may shift you to the operation theatre to examine under anesthesia.

5. If these complaints are frequently recurring even after treatment, your surgeon may advise you to take a colonoscopy (a scope that’s inserted into your anus and guided inside to image and study the entire large intestine) to detect any underlying issues like cancers or inflammatory bowel disorders.

Treatment options for anal disorders

A good thing about anal disorders like fistula piles and fissures is that they could be treated, both by medical and surgical options.

1. Medical options

Gastroenterology doctors prescribed painkillers, antibiotics in case of infections, topical anesthetic creams and stool softeners like liquid paraffin to help ease defecation. Further you may be advised enemas.

2. Surgical options

There are plenty of options to completely cure piles fissure and fistula.

3. Supportive management

In addition to the above, the patient should follow a high-fibre diet toand ease defecation. Further, plenty of oral fluids should be taken, spicy food to be avoided. Do not wipe your bottom harshly after defecation, instead use lukewarm water soaked tissues.

4. Sitz Bath

This is a method advised for anal disorders like fissures or piles to relieve pain. In this, the patient takes a large, shallow non-metallic bowl filled with lukewarm water and antiseptic solution. Then they have to sit in this bowl for a short while, twice or thrice a day. This provides a brief relief from pain and discomfort.

How to prevent piles, fissure and fistula?

1. Avoid straining at stools.

2. Don’t hold defecation, hit the toilet as and when you feel the urge.

3. Eat a high-fiber diet.

4. Drink plenty of fluids.

5. Regular exercise helps improve digestion and ease defecation.

6. Do not misuse laxatives.

7. Do not sit too long, try to move around whenever you could get a chance.

8. Try to reduce weight if you are overweight for your height and age.

Home remedies for pilese fissure and fistula

Home Remedies for Piles and Anal Fissures

Hemorrhoids, also known as piles, as well as anal fissures can be very uncomfortable and painful conditions. Fortunately, there are many common household treatments that provide relief and help with controlling the discomfort brought on by these conditions. While these treatments might not be a replacement for medical guidance, they can offer much-needed comfort. Here are some home remedies that you can try if you are suffering from the condition: 

• Diet High in Fiber: For those who suffer from piles or anal fissures, a diet high in fiber is essential. Fiber softens stools, which makes them simpler to pass and lessens the tension experienced during bowel motions. Dietary fiber can be found in abundance in fruits, vegetables, whole grains, legumes, and legume products.

• Staying Hydrated: Staying hydrated keeps your stools soft, which eases the strain on your body while you're defecating. It's important to hydrate well throughout the day.

• Sitz Baths: A sitz bath, which involves soaking the affected area in warm water, helps ease pain, itching, and other symptoms. This straightforward treatment encourages cleaning and calms irritated tissues.

• Topical Ointments: Applying witch hazel, aloe vera gel, or over-the-counter treatments to the affected area will help lessen irritation and inflammation. These chemicals have anti-inflammatory qualities that offer comfort.

• Good Hygiene: Maintaining good hygiene in the anal region is important. After bowel movements, gently wash the region with mild soap and water, being careful not to scrub or wipe too hard.

• Physical activity: Regular exercise can help maintain good bowel motions, avoid constipation, and lower the risk of piles as well as anal fissures.

• Elevated Feet: Sitting on the toilet with your feet elevated can resemble squatting, which eases strain and facilitates bowel movements.

Home Remedies for Fistula

A painful and upsetting condition is a fistula, which is an irregular tunnel-like connection between two body parts. Even though medical therapy is frequently necessary, some home remedies can provide comfort and hasten the healing process. Keep in mind that seeking medical advice is essential before using any therapies. Here are some home remedies that you can try if you are suffering from the condition: 

• Warm Compresses: Warm, wet compresses applied to the afflicted area can help reduce pain and encourage drainage. The body's natural healing processes may be aided by the heat's increase in blood flow.

• Sitz Bath: A sitz bath, which involves soaking the affected area in warm water, helps ease pain, itching, and other symptoms. This straight forward treatment encourages cleaning and calms irritated tissues.

• Turmeric: Warm milk can be drunk with turmeric, which has anti-inflammatory and therapeutic qualities, or turmeric paste can be administered externally. It might help to lessen inflammation and assist the body's natural healing processes.

• Aloe vera gel: Aloe vera gel can be applied to the affected region to provide a cooling effect and to help soothe it. The inherent healing abilities of aloe vera may aid in general healing.

• Proper Hygiene: It's essential to keep the afflicted region impeccably clean. Infection can be avoided and healing can be accelerated by thoroughly drying the area after gently cleansing it with mild soap and water.

• Changing your food: Eating a diet high in fiber will help to soften stools and prevent constipation, which can make discomfort worse. Drinking enough water is crucial for keeping regular bowel motions.

• Healthy Lifestyle: Reducing stress levels and upholding a healthy way of life can aid the body's inherent healing abilities.

Take-home message

Anal disorders are very common and cause a great deal of discomfort and disruption in the day-to-day lives of those affected. But, fortunately they can be prevented or treated, hence it’s important to receive medical guidance if you are suffering from any of these complaints.

Wishes for a happy and healthy life!

Reference

Health Harvard

NCBI