Anal Pain: Is It a Fissure or Hemorrhoids?

I am not sure if it is an anal fissure or hemorrhoids?

A few days ago, I experienced a sharp pain in my anal area while having a bowel movement.
I usually have a bowel movement every day, but the pain has gradually decreased over the past few days.
Initially, the pain was widespread, but now it is localized to one specific area and only occurs during bowel movements.
After finishing, I typically do not feel any pain.
However, today there was still a bit of pain, and although I haven't noticed any lumps, when I applied medication at night, I felt something like a small lump in the painful area.
Additionally, when standing or walking, I feel something unusual in my anus, as if there is something there intermittently.
I have not experienced any bleeding.
Could I have an anal fissure or hemorrhoids? What could be the issue? Thank you.

YAN, 20~29 year old female. Ask Date: 2015/12/22

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the likelihood of an anal fissure is higher.
Common symptoms include pain during bowel movements accompanied by slight bleeding, often with a history of constipation or diarrhea.
Treatment primarily involves topical ointments and suppositories, along with warm sitz baths to effectively alleviate pain.
However, it is essential to address the underlying bowel movement issues; otherwise, the treatment will only be symptomatic and not curative, potentially leading to chronic anal fissures with recurrent episodes.
To obtain a definitive diagnosis, a personal examination by a physician is necessary.

Reply Date: 2015/12/22

More Info

When it comes to anal pain, distinguishing between a fissure and hemorrhoids is crucial for appropriate treatment. Based on your description, it seems you are experiencing localized pain during bowel movements, which has gradually decreased over time. The presence of a "lump" or "something" in the area, along with the pain that intensifies during defecation, raises the possibility of either an anal fissure or hemorrhoids.

Anal Fissures: An anal fissure is a small tear in the lining of the anus, often caused by passing hard stools or straining during bowel movements. Symptoms typically include sharp pain during and after bowel movements, which can be quite severe. You mentioned that the pain is localized and that you have not observed any bleeding, which is common in fissures. The "lump" you felt could be a spasm of the anal sphincter or a small skin tag that sometimes accompanies fissures.

Hemorrhoids: On the other hand, hemorrhoids are swollen blood vessels in the rectal area. They can be internal or external. Internal hemorrhoids usually do not cause pain unless they prolapse (protrude outside the anus), while external hemorrhoids can cause pain, especially if a clot forms (thrombosed hemorrhoid). Symptoms may include itching, discomfort, and sometimes bleeding during bowel movements. The sensation of something being present in the anal area could also indicate hemorrhoids, particularly if you are feeling a lump.

Diagnosis and Treatment: Given that you have not experienced bleeding, it is less likely that you have a severe condition, but it is still essential to monitor your symptoms. Here are some steps you can take:
1. Dietary Changes: Ensure you are consuming a high-fiber diet to soften stools and reduce straining during bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying well-hydrated is also crucial.

2. Topical Treatments: Over-the-counter creams or ointments containing hydrocortisone or witch hazel can help reduce inflammation and provide relief from pain and itching. If you suspect a fissure, topical anesthetics may also be beneficial.

3. Warm Sitz Baths: Taking warm baths can help soothe the anal area and promote healing. This can be done several times a day, especially after bowel movements.

4. Avoid Straining: Try to avoid straining during bowel movements. If you feel the urge to go, do not delay it, as this can lead to harder stools.

5. Consult a Healthcare Provider: If your symptoms persist or worsen, it is advisable to consult a healthcare provider for a thorough examination. They may perform a physical examination or recommend further diagnostic tests to determine the exact cause of your pain.

In summary, while both anal fissures and hemorrhoids can cause similar symptoms, the key differences lie in the nature of the pain, the presence of lumps, and any associated bleeding. Since your pain is localized and has been gradually improving, it may indicate a minor issue, but it is always best to err on the side of caution and seek medical advice if you have any concerns. Early intervention can prevent complications and lead to more effective treatment.

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