What is the Difference Between Piles, Fissures and Fistula?

Overview

With over 20 million reported cases across India every year, Piles is a common medical condition that can affect many. As the pandemic forced people to work from the safety of their homes, and with easy access to fast food that’s nutritionally deficient, causing digestive issues and obesity.  Piles has become an even more widespread concern among the general population, and is no longer a condition that affects only the elderly. 

There’s a common misconception that piles is the same as an anal fissure or fistula. Though it’s easy to confuse these three conditions as one, it’s important to understand the difference between them and be aware of the factors that contribute to these increasingly prevalent disorders. 

So, before we delve deeper in to the similarities and differences between piles, fissures and fistula, let’s get a quick overview of anal disorders.

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What are anal disorders?

The anus is the opening located at the far end of the digestive tract, through which stool or excrement is expelled. The length of the anus is around 4-5 cm and has sensitive nerve endings that are surrounded by blood vessels.

Piles, fissures and fistulas are all characterized as anal disorders. Other disorders that affect the anus include constipation, colitis and polyps. While each of these disorders differ from each other, the distinction between piles, fistulas, and fissures is frequently misunderstood. 

How are piles, fissures and fistulas different from each other?

Piles

Also known as hemorrhoids, piles are characterized by swollen blood vessels around the opening of the anus. The veins around your anus tend to stretch under pressure and may bulge or swell, forming a ring around the anal cavity, causing outer hemorrhoids. The other type of hemorrhoids known as internal hemorrhoid are formed inside the rectum, and are usually painless. Usually, patients suffering from piles get well on their own before serious negative effects manifest. Straining during bowel movements, having chronic diarrhoea or constipation, obesity, pregnancy and low fibre diets are usual causes.

Fissures

Fissures are identified by a tear around the anal region, and can be exceedingly painful and uncomfortable. In extreme cases medication or surgery might be required to properly treat an anal fissure. Fissures are commonly found in people above the age of 50. Fissures can appear in a variety of forms, including acute and chronic ones. With a fiber-rich diet and proper treatment, a severe fissure can be completely healed. 

Fistula

An anal fistula is a small tunnel that connects an infected gland inside the anus to an opening on the skin around the anus. Just inside the anus are a number of small glands that make mucus. Occasionally, these glands get clogged and can become infected, leading to an abscess. About half of these abscesses may develop into a fistula.

What are the symptoms of these anal disorders?

The most common symptoms of piles, fissures and fistulas are listed below:

Piles

• Bloody stool
• Burning sensation around the anal opening
• Lumps around the anus
• Abdominal pain

Fissures

• Bowel movements cause severe pain
• Bleeding occurs after bowel movement
• Presence of a lump or a skin tag near the anus

Fistulas

• Pain and swelling around the anus
• Bloody or foul-smelling drainage (pus) from an opening around the anus. The pain may decrease after the fistula drains.
• Irritation of the skin around the anus from drainage
• Pain with bowel movements
• Bleeding
• Fever, chills and a general feeling of fatigue

When do you need to visit a doctor?

If you experience bleeding during a bowel movement that doesn’t improve even proper home care, it is recommended to visit your Apollo doctor at the earliest.

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What are the various reasons for these three conditions to occur?

In most cases, piles form as a result of applying excessive pressure or straining of the lower rectum. Frequent constipation, chronic diarrhea, lifting heavy weights, pregnancy, and straining while passing feces are all possible causes of piles. Symptoms which can help identify the presence of hemorrhoids include the presence of bright red blood in stool, itchy anus and pain around the anal region while passing stool.

Anal fissure is a tear in the thin tissue that lines the anal cavity. Common reason for anal fissures includes passing hard stools, constipation, childbirth, anal intercourse or chronic diarrhea. Fissures can also be caused by Crohn’s disease, HIV, Anal cancer, Tuberculosis, and Syphilis.

Fistulas form when the  glands in the anus get blocked. Accumulation of bacteria can lead to pocket abscesses. Surgery is almost always necessary to cure an anal fistula. The surgery is performed by a colon and rectal surgeon. The goal of the surgery is a balance between getting rid of the fistula while protecting the anal sphincter muscles, which could cause incontinence if damaged.

What are the complications associated with piles, fissures and fistula?

Piles and anal fissures are usually not a cause of concern, but they can become severe if a swollen knot-like structure form around the anus opening. The formation of this structure often indicates the presence of multiple swollen blood vessels, resulting in pain and discomfort.   If the blood supply to an internal haemorrhoid is cut off, the haemorrhoid may be “strangulated,” which can cause extreme pain. Occasionally, a clot can form in a haemorrhoid (thrombosed haemorrhoid).

Complications arise when anal fissures do not heal for an extended period of time. Under such a situation medical supervision is recommended.

Fistulas necessitate medical treatment and cannot be treated through home remedies. All treatments for fistula aim at draining the infection away and restoring normalcy for the patient through a combination of drugs and surgery. Untreated fistulas can lead to formation of more fistulas which then makes it more difficult to operate and cure and the recurrence rate in these cases is much higher. 

What are the preventive steps that can be taken to avoid piles, fissures and fistulas?

Preventive methods for piles, fissures and fistulas are very similar to each other: 

1. Consuming fiber rich foods to help avoid excessive strain while passing stool.  
2. Drinking at least 6 to 8 glasses of water a day. 
3. Avoid holding your breath while passing stool as this causes excessive pressure in the veins of the lower rectum. 
4. Avoid sitting for extended periods at the same place.
5. Exercise every day for at least 30 minutes. Lack of physical activity causes constipation which in turn can lead to these ailments.
6. For infants, it is necessary to change diapers frequently.
7. Maintaining proper anal hygiene.

Also Read About: Solitary Rectal Ulcer Syndrome

A Note from Apollo Hospitals

All anal disorders have to be treated with patience, medication and surgery, if necessary. Leaving these symptoms untreated for an extended period of time can lead to serious complications. 

Given the sensitive nature of anal disorders, patients may hesitate to get medical help for these conditions unless the symptoms become severe and unmanageable. Hence, it’s recommended to openly discuss your symptoms with your doctor at an early stage to avoid complications and significant discomfort. You can reach out to specialists at Apollo anytime to help chart your next course of action if you are suffering from any of these diseases.

Frequently Asked Questions (FAQs)

Which surgical technique is used to treat piles?

Rubber band ligation, Injection (sclerotherapy) or Coagulation (infrared, laser or bipolar) as well as surgical procedures like Haemorrhoid removal (haemorrhoidectomy) or Haemorrhoid stapling may be used to treat piles.

Is anal fissure usually itchy?

Yes, anal fissures tend to cause irritation around the anal canal which can cause mild discomfort and itchiness. You can use non-medicated talcum powder to reduce the itchiness and ensure proper anal hygiene to enable faster healing. 

Does a fistula heal on its own?

Fistulas cannot heal on their own without proper medications/surgery. If left untreated for an extended period of time, they can result in serious complications.