Difference Between Piles and Fistula
By Dr. Nikita Toshi +2 more
Medically reviewed by Dr. Nikita Toshi
Last updated: Oct 25, 2024 Published on: Feb 6, 2023
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By Dr. Nikita Toshi +2 more
Table of Contents
Piles, also known as haemorrhoids, are swelling of enlarged blood vessels around the anal area. It is a painful condition, the first signs include straining and blood loss while passing stools and discomfort while sitting, walking and other movements. Piles can be internal and form within the rectum or they can be external and protrude beyond the anus.
An anal fistula is a tunnel which forms in an infected gland of the anus, it extends till the opening around the anus. It can be a result of an injury or surgery and cause pain and inflammation around the anus.
| Different Factors | Piles | Fistula |
| Causes | If you put excess pressure or strain the veins around your anus during bowel movements, it may swell. Some other causes of this condition are: Straining during bowel movementsSevere diarrhoea ObesityRegular heavy lifting Pregnancy | Fistula may develop due to: An infection in the anal gland Abscess around anal region TraumaRadiation therapy or treatment of anal cancer |
| Symptoms | Imaging tests like MRI, CT Scan or Fistulogram to identify the path of the fistula. Other tests include a fistula probe, anoscope, flexible sigmoidoscopy or colonoscopy. | Itching or irritation in the anal area Bleeding during bowel movements Pain/discomfort while passing hard stools Discomfort while prolonged sitting or standing up |
| Diagnosis | Digital or clinical examination of the rectum is done by inserting a lubricated finger and looking for any unusual swellings. Visual inspection of the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. | Medicines for local application Sitz bath A fistulotomy is done by removing the fistula along with it’s linning, cleaning it and allowing it to heal. Fibrin glue and collagen plug to clean and seal the tunnel. Seton placement into the fistula to drain the infection and contents inside the tunnel. Endorectal advancement flap uses a flap from the rectal wall to cover the fistula. LIFT is a two-stage treatment in which the fistula tunnel is opened, then the infected tissues are removed and the fistula is tied off. |
| Treatment options that can be advised by doctors | Medicines for local application Soak the anal area in warm water or a sitz bath. Rubber band ligation is done by using rubber bands around the base of an internal haemorrhoid to cut off its blood circulation. Injection (sclerotherapy) is done to shrink the tissues in the haemorrhoid. Haemorrhoid removal (hemorrhoidectomy) to remove excessive tissue that causes bleedingHaemorrhoid stapling to block blood flow to haemorrhoidal tissue | Medicines for local application Sitz bath A fistulotomy is done by removing the fistula along with its linning, cleaning it and allowing it to heal. Fibrin glue and collagen plug to clean and seal the tunnel. Seton placement into the fistula to drain the infection and contents inside the tunnel. The endorectal advancement flap uses a flap from the rectal wall to cover the fistula. LIFT is a two-stage treatment in which the fistula tunnel is opened, then the infected tissues are removed and the fistula is tied off. |
| Prevalence | Piles is very common in adults. Women are more prone to developing haemorrhoids than men. | Anal fistulas commonly develop around the age of 40. It affects males more than females. |
| Complications if left untreated- | Anemia. Chronic blood loss due to piles may lead to anaemia. Strangulated haemorrhoid. If the blood supply to an internal haemorrhoid is cut off, the tissue may get severely infected and can cause extreme pain. Blood clot. Occasionally, a clot can also form in a haemorrhoid due to a lack of blood flow (thrombosed haemorrhoid). It can be extremely painful. | A recurring fistula or an abscessIncrease in the length and number of tracts Inability to control bowel movements (fecal incontinence). Sepsis or infection that spreads throughout the body Peritonitis. An intestinal fistula may cause inflammation and infection of the peritoneum (membrane lining the abdominal cavity). There is a risk of developing cancer in the fistula tract if left untreated for a long period of time. |
In simple terms Piles is a condition in which blood vessels swell up, whereas a fistula is marked by the development of a tunnel from the anus to surrounding skin.
Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)
Piles and fistula are two distinct conditions. However, it is possible for you to get confused between the two and their symptoms. If you ignore the symptoms of piles, such as pain, itching in the anal area, blood in stools and the symptoms of fistula, such as blood and foul-smelling discharge, pain in the rectum, swelling in the anal area and visibility of a tunnel at the opening of the anus, both the conditions may worsen over time and cause other complications. Consult a doctor to learn more about the difference between piles and fistula and seek appropriate treatment. Never self-medicate, proper diagnosis of your condition is the first step towards living a pain-free life.
Fissures, piles and fistula are often confused as being the same conditions in an individual. Fissures usually heal on their own within a couple of days or weeks. Piles and fistulas usually require medical or surgical intervention.
Dr. Ashish Bajaj, M.B.B.S., M.D. in Clinical Pharmacology and Toxicology
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