Hemorrhoids vs. Anal Fissure: Causes, Symptoms, and Treatment

Hemorrhoids are swollen blood vessels in the rectum/anus, while anal fissures are small linear tears in the anal lining. Both are extremely common and cause rectal discomfort and bleeding, but their pain patterns and treatment approaches differ.

Key Differences at a Glance

Structure
Hemorrhoids
Swollen blood vessels (varicose veins of rectum)
Anal Fissure
Linear tear in the anal skin lining
Pain Pattern
Hemorrhoids
Dull ache, itching, pressure; may be painless (internal)
Anal Fissure
Sharp, tearing pain during and after bowel movements
Bleeding
Hemorrhoids
Painless bright red blood dripping into toilet
Anal Fissure
Bright red blood on toilet paper with sharp pain

Shared Symptoms

  • Rectal bleeding
  • Anal discomfort
  • Worsened by constipation

Unique Indicators

ONLY Hemorrhoids
  • Itching
  • Palpable lump at anus
  • Mucus discharge
  • May be painless
ONLY Anal Fissure
  • Intense sharp pain during bowel movements
  • Pain lasting minutes to hours after
  • Visible tear on examination
  • Anal spasm

Professional Diagnosis

Both are diagnosed by clinical examination. Hemorrhoids may require anoscopy. Fissures are usually visible on gentle external exam. Underlying conditions should be considered if atypical.

Treatment for Hemorrhoids

High-fiber diet, adequate hydration, sitz baths, topical treatments, rubber band ligation for internal hemorrhoids, and surgical excision for severe cases.

Treatment for Anal Fissure

High-fiber diet, sitz baths, topical nitroglycerin or calcium channel blocker ointments to relax the sphincter, and lateral internal sphincterotomy for chronic fissures.

When to See a Doctor

See a doctor for persistent rectal bleeding (to rule out other causes), a painful lump that does not improve, or symptoms that recur frequently despite home treatment.

Not sure which one you have?

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Medically Reviewed for Accuracy

Medical Advisory Board
Last reviewed: March 20, 2026

Content is aligned with established clinical guidelines from authoritative medical institutions, including MedlinePlus (U.S. National Library of Medicine), the CDC, the NIH, and the NHS. All content is reviewed by our medical advisory board for accuracy and safety.