the Differences Between Hemorrhoids and Anal Fissures

Q: the Differences Between Hemorrhoids and Anal Fissures

Hello, Xiao Xiao： Anal fissures occur when hard stools tear the anal mucosa, leading to pain during bowel movements. <br>The pain associated with bowel movements makes patients more reluctant to use the restroom, worsening constipation and creating a vicious cycle. <br>If externa

What is the difference between hemorrhoids and anal fissures?

Dr.
Lin, I would like to ask you about the differences between hemorrhoids and anal fissures.
For the past six months, I have been experiencing pain in the anal area during bowel movements, and occasionally I notice some bleeding.
When I take a shower, I can feel a small protrusion located just below the vaginal opening on the front side of the anus (about 0.5 to 1 cm in size).
The pain only occurs after a bowel movement; otherwise, I feel no pain and do not have any prolapse.
Could this be external hemorrhoids or an anal fissure? What self-treatment options are available? I have been suffering from chronic constipation for a long time, often going 4 to 5 days without a bowel movement.
How can I improve this situation?

Xiao Xiao, 10~19 year old female. Ask Date: 2005/04/12

Dr. Lin Hongmao reply Surgery

Hello, Xiao Xiao: Anal fissures occur when hard stools tear the anal mucosa, leading to pain during bowel movements.
The pain associated with bowel movements makes patients more reluctant to use the restroom, worsening constipation and creating a vicious cycle.
If external hemorrhoids cause swelling and pain, the discomfort may persist beyond just bowel movements, which suggests that you may be experiencing an anal fissure.
Acute anal fissures typically do not require surgery; improving bowel habits, avoiding excessive strain on the anus, and regularly taking sitz baths can help reduce pressure on the anal sphincter, making healing of acute anal fissures relatively straightforward.
Chronic anal fissures, however, may require surgical intervention.
Surgery usually involves excising the fibrotic fissure and may also include cutting the internal anal sphincter to relax the anal area and reduce pressure during bowel movements.
This type of surgery is simple and effective.
However, the diagnosis and treatment of hemorrhoids and anal fissures differ, so it is crucial to see a colorectal specialist to confirm the diagnosis.
To thoroughly address constipation, it is essential to focus on lifestyle and dietary habits.
Drinking a large glass (500cc) of cold water or honey water first thing in the morning before eating can effectively stimulate gastrointestinal motility and aid in bowel movements.
Incorporating brown rice and whole grains into your main meals, along with fruits like bananas, grapefruit, and watermelon, can also promote bowel regularity.
Additionally, drinking at least 2000cc of water daily and having a cup of coffee after breakfast or lunch can further stimulate gastrointestinal motility.
Alongside dietary adjustments, you may also consider massage and enemas for enhanced results.
Regarding constipation, here are some important points: While many people resort to laxatives to manage constipation, indiscriminate use of stimulant laxatives can cause abdominal pain and lead to dependency, resulting in constipation when not taken.
Furthermore, the colon may develop pigmentation changes known as melanosis coli due to the irritation from these medications.
Observations via colonoscopy may reveal a completely darkened colon, and prolonged use can damage the nerve and muscle tissues of the intestinal wall, potentially leading to polyps and increasing the risk of colorectal cancer.
Establishing a bowel habit should be gradual; it is essential to remain relaxed, as anxiety about bowel movements can hinder the ability to defecate.
Remember, digestion and emotions are both controlled by the nervous system.
When you feel the urge to go, respond promptly; delaying can cause the rectum to tighten, sending mixed signals to the body and preventing muscle relaxation.
Therefore, act on the urge when it arises.
Lastly, try to maintain a regular schedule for bowel movements daily or weekly to establish a routine.
Be cautious not to consume excessive fiber or to pair fiber intake with insufficient hydration, as this can lead to constipation and, in worse cases, intestinal obstruction.
Fiber supplements can be difficult to regulate.
The best approach is to consume high-fiber foods while gradually increasing fiber intake to give your body adequate time to adjust.
I hope this information answers your questions! If you have further concerns, feel free to visit our clinic for assistance! Sincerely, Lin Hong-Mao.

Reply Date: 2005/04/12

More Info

Understanding the differences between hemorrhoids and anal fissures is crucial for effective diagnosis and treatment. Both conditions can cause discomfort and bleeding, but they have distinct characteristics and underlying causes.

Hemorrhoids are swollen veins in the lower rectum or anus, similar to varicose veins. They can be classified into two types: internal and external. Internal hemorrhoids occur inside the rectum and are usually not visible. They may cause painless bleeding during bowel movements, which can be alarming but is often not serious. External hemorrhoids, on the other hand, develop under the skin around the anus. They can cause pain, especially during bowel movements, and may be accompanied by swelling or a lump near the anus. The lump you described, located just below the vaginal opening, could potentially be an external hemorrhoid, especially if it is tender or painful during bowel movements.

Anal fissures, on the other hand, are small tears in the lining of the anus. They typically occur due to trauma from passing hard stools, which is common in individuals with chronic constipation. Symptoms of anal fissures include sharp pain during and after bowel movements, as well as possible bleeding. The pain can be severe and may lead to a fear of bowel movements, which can exacerbate constipation.

Given your symptoms of pain during bowel movements and the presence of a small lump, it is possible that you are experiencing external hemorrhoids. However, the pain you feel could also be indicative of an anal fissure, especially if the pain is sharp and associated with bleeding. The fact that you have a history of chronic constipation further supports the likelihood of fissures, as straining to pass hard stools can lead to both conditions.

Self-Treatment Options:
1. Dietary Changes: Increasing your fiber intake can help soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Aim for at least 25-30 grams of fiber per day.

2. Hydration: Drinking plenty of water is essential for preventing constipation. Aim for at least 8 glasses of water a day.

3. Regular Bowel Habits: Establishing a regular schedule for bowel movements can help. Try to go at the same time each day, and don’t ignore the urge to go.

4. Over-the-Counter Treatments: You may consider using topical treatments such as hydrocortisone creams or witch hazel pads for hemorrhoids. For anal fissures, topical anesthetics or nitroglycerin ointments may help relieve pain and promote healing.

5. Warm Baths: Soaking in a warm bath can provide relief from pain and help relax the anal sphincter, which may aid in healing.

6. Avoid Straining: When you feel the urge to have a bowel movement, try not to strain. If you are having difficulty, consider using a stool softener or a mild laxative, but consult with a healthcare provider before starting any medication.

If your symptoms persist or worsen, or if you experience significant bleeding, it is important to consult a healthcare professional for a thorough evaluation. They may recommend further treatments, such as prescription medications or, in some cases, surgical options for hemorrhoids or fissures.

In summary, while both hemorrhoids and anal fissures can cause similar symptoms, they are distinct conditions with different causes and treatments. Addressing your chronic constipation through dietary changes and proper hydration is key to preventing both conditions from recurring.

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