Difference between Piles vs Fissure
By Dr. Vishesh Bharucha +2 more
Medically reviewed by Dr. Vishesh Bharucha
Last updated: Oct 1, 2025 Published on: Jan 30, 2023
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By Dr. Vishesh Bharucha +2 more
Table of Contents
Piles, also known as haemorrhoids, are vascular cushions of the anal canal that become pathologically enlarged, inflamed, or symptomatic. It can be internal and form within the rectum (usually painless) or external and protrude beyond the anus (painful, especially if thrombosed).
The first signs include painless rectal bleeding (fresh blood in stool or on toilet paper). External haemorrhoids or prolapsed internal haemorrhoids can cause pain/discomfort while sitting, walking, and performing other movements1,2.
An anal fistula is a tract connecting the anal canal or rectum to the perianal skin, with the external opening on the skin near the anus and the internal opening inside the anal canal. It commonly forms from a perianal abscess originating in an anal gland (cryptoglandular infection)3. However, not all fistula are due to an infection; there are other causes too.
| Different Factors | Piles | Fistula |
| Causes | Common causes include straining during bowel movements, chronic constipation, and severe diarrhoea. Obesity also contributes to increasing pressure in the rectal area. Pregnancy and childbirth further predispose individuals to hemorrhoids due to increased pelvic pressure and hormonal changes. Although heavy lifting can raise intra-abdominal pressure and worsen hemorrhoids, it is considered a less common risk factor compared to persistent constipation1,4. | Most anal fistulas arise as a natural progression from an anal gland infection leading to a perianal abscess, which then develops into a fistula. Other important causes include inflammatory bowel disease, particularly Crohn’s disease, and infections such as tuberculosis, which are more often associated with complex or atypical fistulas. Trauma, radiation therapy, or prior treatment for anal cancer may also contribute in some cases3,5. |
| Symptoms | Bright red bleeding after passing stools, itching around the anus, soreness, redness, swelling, or a lump that may protrude and sometimes needs to be pushed back in (mainly with large or thrombosed internal hemorrhoids). Other possible signs include a mucus discharge following bowel movements4. | Persistent pus or fluid discharge from an opening near the anus, swelling and pain that may come and go, and sometimes redness or fever. Anal pain is common, especially during bowel movements, and in women, a rectovaginal fistula may also cause the passage of stool or gas through the vagina3,5. |
| Diagnosis | Digital rectal examination (DRE) helps detect internal haemorrhoids, anal masses, strictures, and internal fistula openings, while also assessing sphincter tone, tenderness, and palpable tracts. Anoscopy or proctoscopy allows direct visualisation of the anal canal and distal rectum. Flexible sigmoidoscopy can evaluate up to the sigmoid colon, but not the full colon, for which colonoscopy is required1,6. | Diagnosis of an anal fistula is mainly clinical, based on a history of abscess and persistent discharge, and is confirmed with examination (digital rectal exam, probing, or anoscopy). MRI pelvis is the gold standard for mapping tracts, while endoanal ultrasound may also be used; colonoscopy is considered if Crohn’s disease or malignancy is suspected5. |
| Treatment options that can be advised by doctors | Conservative measures such as sitz baths help relieve discomfort, itching, and irritation, but are not considered medicinal treatments. Rubber band ligation is a procedure for Grade II–III internal haemorrhoids, where a band is placed at the base to cut off the blood supply, causing the haemorrhoid to shrink; it is not used for external haemorrhoids. Sclerotherapy involves injecting a sclerosant to induce fibrosis and reduce the size of Grade I–II internal haemorrhoids and is ineffective for external haemorrhoids. Haemorrhoidectomy is the surgical removal of excessive tissue, typically reserved for severe or symptomatic haemorrhoids causing persistent bleeding1,2. | Conservative measures such as sitz baths may provide symptomatic relief, while topical medicines (antibiotics, analgesics, or anti-inflammatories) can be used in selected cases. Standard fistulotomy involves surgically opening the fistula tract to allow drainage and healing by secondary intention, rather than removing its lining. Fibrin glue or collagen plugs are minimally invasive options that seal the tract to promote healing, though success rates vary. Seton placement is often used for complex or high fistulas, permitting controlled drainage and fibrosis while preserving sphincter function. The endorectal advancement flap technique uses a flap of rectal wall to cover the internal opening of the fistula. The LIFT (ligation of intersphincteric fistula tract) procedure is a sphincter-preserving surgery that involves identifying, ligating, and excising the intersphincteric tract in a single stage5,7. |
| Prevalence | Piles are very common in both genders. However, women are more prone to developing haemorrhoids than men8. | Anal fistulas commonly develop around the age of 40. It affects males more than females3. |
| Complications if left untreated- | Complications of haemorrhoids may include severe pain and ischemic necrosis, while infection is rare. Anaemia from chronic blood loss may also occur, especially with persistent bleeding. Strangulated haemorrhoids occur when an external or prolapsed internal haemorrhoid becomes trapped, leading to impaired blood flow9. | Complications of untreated or severe fistulas may include recurrence of the fistula or abscess, an increase in the length and number of fistula tracts, and faecal incontinence due to sphincter involvement. In some cases, sepsis can occur if the infection spreads throughout the body. Peritonitis may develop when an intestinal fistula causes inflammation or infection of the peritoneum. Long-standing, untreated fistulas also carry a small risk of malignant transformation within the fistula tract10,12. |
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.
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
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.
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
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