Anal fissure or haemorrhoids: how to tell the difference

2026-11-09

• An anal fissure is a tear in the lining of the back passage; haemorrhoids are enlarged vascular cushions.
• A fissure typically causes sharp, cutting pain during and after a bowel movement; internal haemorrhoids bleed painlessly.
• Both are often triggered by hard stools and straining, so the basics of care are shared: fibre, water, soft stools.
• A fresh fissure often heals within a few weeks, while a chronic one needs treatment by a proctologist.
• Heavy bleeding, black stools, fever or severe throbbing pain mean you should see a doctor urgently.

A trip to the toilet that turns into an ordeal: a sharp pain as if something is cutting, a few drops of bright red blood on the paper, and then a long-lasting ache and burning. Many people immediately think it must be haemorrhoids. Sometimes it is — but not always.

An anal fissure, a small tear around the back passage, causes very similar complaints. The two conditions are often confused, even though they need different care. Let us look at how to tell an anal fissure from haemorrhoids, what helps in the first few days and why an examination by a proctologist is essential.

What is an anal fissure, and what are haemorrhoids?

An anal fissure is a lengthwise tear in the thin lining of the anal canal. It most often appears when a hard, bulky stool is passed, and less often with frequent loose stools. Usually it sits at the back wall, towards the tailbone. The wound is irritated with every bowel movement, and the sphincter muscle goes into spasm in response, which slows healing.

Haemorrhoids are enlarged and displaced vascular cushions that everyone has in the anal canal. Internal haemorrhoids sit higher up and usually do not hurt; external ones lie under the skin at the edge of the anus. Read more about the difference in external and internal haemorrhoids: how to tell them apart.

How does the pain differ?

The type of pain is the main clue.

• With an anal fissure, the pain is sharp and cutting, often described as like passing glass. It starts during the bowel movement and can last from a few minutes to several hours afterwards. Many people become afraid of the toilet and put it off, which only makes constipation worse.
• Internal haemorrhoids usually do not hurt. Discomfort, itching, a feeling of incomplete emptying and lumps that come down when straining are more typical.
• When an external haemorrhoid thromboses, there is sudden, constant pain and a firm, tender lump at the edge of the anus that is not linked to passing a stool.

How does the bleeding differ?

Both conditions can bleed, but the blood looks slightly different.

• With a fissure, there is usually only a little blood: bright red streaks on the toilet paper or on the surface of the stool, almost always together with pain.
• With internal haemorrhoids, the blood is also bright red, but there may be more of it: it drips or splashes into the toilet after a bowel movement, often with no pain at all.

In both cases the blood is bright because the source is close to the opening. Dark blood, clots, black stools or blood mixed into the stool point to another source and need urgent investigation.

What other signs can help you get your bearings?

Besides pain and bleeding, look out for these details:

• A lump. Lumps that come down and go back by themselves or with a finger are typical of haemorrhoids. At the edge of a long-standing, chronic fissure a small skin tag, known as a sentinel tag, may form and is easily mistaken for an external haemorrhoid.
• Itching and mucus. These are more common with haemorrhoids, although they can occur with a fissure too.
• Duration. A fresh fissure often heals within a few weeks with gentle care. If pain with every bowel movement lasts longer than 6–8 weeks, the fissure is considered chronic.
• Both at once. Fissures and haemorrhoids often occur together because they share the same causes.

This comparison helps you know what to tell your doctor, but only an examination can tell one from the other for certain.

What should you do in the first few days?

While you wait for an appointment, the basics are the same for a fissure and for haemorrhoids: make your stools soft and reduce irritation.

1. Add fibre to your diet: vegetables, fruit, legumes and whole grains. Our article on fibre for haemorrhoids shows how to do this with familiar Uzbek food.
2. Drink enough water throughout the day.
3. Do not put off the urge, do not strain and do not sit on the toilet for long.
4. After a bowel movement, wash with warm water instead of using dry paper, and pat the skin dry with a soft towel.
5. Warm sitz baths for 10–15 minutes help many people relax the sphincter and ease pain, especially with a fissure.

If your stools stay hard, a doctor or pharmacist can suggest a gentle laxative. We explained why chronic constipation is so harmful for the back passage in constipation and haemorrhoids.

How does a doctor treat fissures and haemorrhoids?

A proctologist will start with a conversation and an examination. If a fissure is very painful, the examination is done as gently as possible, and some tests are postponed until the pain settles. If needed, the doctor will arrange an anoscopy or colonoscopy to rule out other conditions.

• An acute fissure often heals with soft stools, sitz baths and local treatments prescribed by the doctor.
• For a chronic fissure, medicines that relax the sphincter are used and, if they do not help, minimally invasive or surgical treatment.
• For haemorrhoids, depending on the grade, options include conservative treatment, minimally invasive procedures such as rubber band ligation, or surgery.

Important: haemorrhoid creams and suppositories are not always suitable for a fissure, and vice versa. That is why treatment is best chosen after an examination rather than on advice from the internet.

When do you need a doctor urgently?

Book an appointment with a proctologist for any rectal bleeding, if pain on passing stools lasts more than a week or two, or if symptoms keep coming back. It is especially important not to delay if you are middle-aged or older, or if bowel cancer runs in your family.

The bottom line

An anal fissure and haemorrhoids are similar but not the same: a fissure cuts and burns during a bowel movement, while internal haemorrhoids tend to bleed without pain. The good news is that the basics of care are shared and very doable: soft stools, water, fibre and gentle hygiene. A proctologist will give you a definite answer and the right treatment — do not let embarrassment hold you back, as for the doctor this is ordinary, everyday work.

Sources: 1. van Tol RR, Kleijnen J, Watson AJM, et al. European Society of ColoProctology: guideline for haemorrhoidal disease. Colorectal Dis. 2020;22(6):650–662. 2. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2018;61(3):284–292.

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