Anal Pain and Bleeding: Fissures vs. Hemorrhoids

Anal pain and bleeding during bowel movements?

About a year ago, I experienced rectal bleeding for 2-3 days after straining during a bowel movement.
Since then, I have noticed blood during bowel movements, with some blood on the stool and when wiping.
I went to the hospital for an examination, and the doctor found a tear near the anal opening, diagnosing it as an anal fissure.
After applying medication, my condition improved, and I was able to have bowel movements without bleeding.
However, in the past few months, I have been having difficulty with bowel movements, and occasionally there is still some bleeding, but not every time.
Recently, for the past few weeks, I have been experiencing bleeding every time I have a bowel movement, and it has become difficult to pass stool, as if my anus is blocked.
Straining causes sharp pain, similar to tearing, making it extremely painful and nearly impossible to pass stool.
However, I cannot avoid it, and when I do push through the pain, I see bright red blood in the toilet.
The toilet bowl is filled with blood, and there is blood on the toilet paper as well.
Afterward, my anus continues to hurt for more than a day.
Now, I am afraid to have a bowel movement at all.
I would like to ask the doctor whether this is still an anal fissure or if I might have developed hemorrhoids.

Niming, 20~29 year old female. Ask Date: 2018/02/02

Dr. Ke Fangxu reply Surgery

Based on your description, it seems more like the typical symptoms of an anal fissure, which include pain during bowel movements accompanied by slight bleeding.
If the bleeding is more significant, it could be due to concurrent hemorrhoidal bleeding.
The common causes are often constipation or diarrhea.
The fundamental treatment is to improve bowel habits, along with warm sitz baths.
You can also purchase hemorrhoid suppositories over the counter for use.
If the symptoms persist without improvement, it is advisable to consult a physician for further evaluation.

Reply Date: 2018/02/02

More Info

Understanding anal pain and bleeding can be quite distressing, especially when it involves conditions like anal fissures and hemorrhoids. Both conditions can cause similar symptoms, such as pain during bowel movements and rectal bleeding, but they have different underlying causes and treatment approaches.

Anal Fissures: An anal fissure is a small tear in the lining of the anus. They often occur due to trauma, such as passing hard stools or straining during bowel movements. The symptoms you described, such as sharp pain during bowel movements, bleeding, and a feeling of tearing, are classic signs of an anal fissure. The pain can be severe, often described as a "stabbing" sensation, and may persist for hours after the bowel movement. The blood is usually bright red and may be seen on the toilet paper or in the toilet bowl.

In your case, it seems that you initially experienced an anal fissure, which was treated with topical medications. However, the recurrence of pain and bleeding suggests that the fissure may not have fully healed, or that new fissures have developed due to ongoing straining or constipation. The fact that you are experiencing difficulty passing stool and a sensation of blockage indicates that you may be straining more, which can exacerbate fissures.

Hemorrhoids: Hemorrhoids, on the other hand, are swollen veins in the rectal area that can be either internal or external. Internal hemorrhoids are usually painless but can bleed during bowel movements, while external hemorrhoids can cause pain, itching, and swelling. The bleeding from hemorrhoids is typically less painful than that from fissures and may appear as bright red blood on the stool or toilet paper.

Given your symptoms, it is possible that you could be experiencing both conditions. The pain and bleeding you describe during bowel movements, along with the sensation of blockage, could indicate the presence of hemorrhoids in addition to the fissures. Straining to pass stool can lead to the development of hemorrhoids, especially if you are experiencing constipation.

Management and Treatment: Here are some recommendations for managing your symptoms:
1. Dietary Changes: Increase your fiber intake by consuming more fruits, vegetables, whole grains, and legumes. This can help soften your stool and reduce straining during bowel movements. Staying well-hydrated is also crucial.

2. Stool Softeners: Over-the-counter stool softeners can help ease bowel movements and reduce the risk of further tearing.

3. Topical Treatments: Continue using topical medications as prescribed by your doctor. These can help alleviate pain and promote healing of fissures.

4. Warm Baths: Soaking in a warm bath can provide relief from pain and help relax the anal sphincter, making bowel movements easier.

5. Avoid Straining: Try to avoid straining during bowel movements. If you feel the urge to go, don’t delay it, as this can lead to harder stools.

6. Consult a Specialist: If your symptoms persist or worsen, it is essential to consult a gastroenterologist or a colorectal surgeon. They can perform a thorough examination to determine the exact cause of your symptoms and recommend appropriate treatments, which may include procedures for more severe cases.

In conclusion, while your symptoms are consistent with anal fissures, the possibility of hemorrhoids should not be overlooked. Proper management of your bowel habits and seeking medical advice will be crucial in alleviating your discomfort and preventing further complications.

Similar Q&A

Anal Fissures vs. Hemorrhoids: Understanding Symptoms and Treatment

Doctor, I know that I have been suffering from anal fissures. Initially, my condition improved as my bowel movements became smoother. However, recently I experienced a severe episode of constipation that caused a tear. Up until this week, I have been experiencing pain during bowe...

Dr. Yu Mingchang reply Surgery
Hello: It should just be an anal issue. Try to maintain soft stools as much as possible. When you have the opportunity, please visit the colorectal clinic at Changhua Hospital for a check-up. We care about you.

Understanding Anal Pain: Could It Be a Fissure or Hemorrhoids?

I have hemorrhoids, both internal and external. Recently, I experience sharp pain around the 4 to 6 o'clock position during bowel movements, but there is no bleeding. My stools are quite soft. Could this be an anal fissure?

Dr. Lin Minghui reply Gastroenterology and Hepatology
Hello, both hemorrhoids and anal fissures are possible. You may visit the Department of Colorectal Surgery or Gastroenterology for a clearer examination, such as a digital rectal exam or anoscopy. Sincerely, Dr. Lin Ming-Hui, Attending Physician, Department of Gastroenterology, T...

Understanding Rectal Bleeding: Hemorrhoids or Anal Fissures?

I had a colonoscopy about two years ago, but it only examined around 60 cm and there were no significant issues found, except for mild internal hemorrhoids. Last year, I had an anal examination, which also indicated the presence of internal hemorrhoids. Recently, I noticed that i...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems likely that you are experiencing an anal fissure combined with hemorrhoidal bleeding. Common symptoms include pain during bowel movements accompanied by slight bleeding, often following a history of constipation or diarrhea. Treatment primarily...

Understanding Anal Pain: Fissures vs. Hemorrhoids in Teens

A few days ago, I experienced anal pain with blood after not having a bowel movement for a day. This has happened two or three times before, but this time the pain has lasted longer (about 3 to 4 days). I eat a lot of fruits and vegetables and drink plenty of water. What could be...

Dr. Ke Fangxu reply Surgery
Based on your description, it seems to be a typical symptom of anal fissure, which is characterized by pain during bowel movements accompanied by slight bleeding. If there is concurrent bleeding from hemorrhoids, the amount of blood may be greater. The primary cause of anal fissu...