Last modified on October 2020
With inputs from Dr. Pragnya Rao - General Physician
People often misunderstand the difference between piles and fistula and fissure. It is assumed that these conditions share similar characteristics. However, this is not the case.In this blog, we decode the difference between piles and fistula and fissure in Indian patients in detail – the what, how, why, and helpful treatments recommended to use for each condition.
To briefly introduce these medical terminologies:
Read along to delve deeper into understanding the difference between piles and fistula and fissure in Indian patients, their primary symptoms and treatment.
“Piles fistula and fissure are often confused for one another. While piles is swollen blood vessels surrounding the anal canal, fissure is a tear or crack in the tissue of the anus and fistula is an abnormal tunnel between the anus and the surrounding skin. If you notice any bleeding or discomfort while passing stools, you should consult with a physician to understand the underlying cause and get treatment for it.”
– Dr. Pragnya Rao, General Physician
The rectum is an organ at the end of the human gastrointestinal system that is responsible for the storage of stools and evacuation through the anus. When the blood vessels (and the surrounding tissues) around the anus develop a swelling, the condition is known as piles.
India records more than 10 million
piles cases every year!
Piles are divided into two broad categories:
The key to understanding the difference between piles and fistula and fissure, is first of all understanding what piles is. Piles develop due to high pressure in the veins of the lower rectum and anal canal. This build-up, in turn, leads to inflammation and swelling in the area.
This may occur on account of various reasons:
The most common symptoms of piles are:
Doctors categorize piles into four grades:
Depending upon the severity of the condition, there are different kinds of treatment for Piles, like the following:
For grade I and II piles, it is possible to treat the disease with the following non-surgical treatment options:
Remember this as
Moreover, various creams, ointments, and pads are available as over-the-counter (OTC) medicines that help ease the symptoms.
In situations of colorectal malignancy (a malignant tumor of the large intestine), it is essential to normalize bowel habits. The solution for this condition includes:
– Piles are the result of the swellings of the blood vessels and tissues surrounding the anal canal.
– Everyday habits determine the chances of developing haemorrhoids. Therefore, it is important to maintain a healthy lifestyle.
– Piles are categorized into four grades. This distinction defines the course of treatment – surgical or non-surgical.
Now that we know what Piles is, read on to further understand the difference between Piles and fistula. and fissure.
Consult top general physicians on MFine to know more about Piles and its symptoms
Many people confuse fistula with piles without knowing the difference between piles and fistula. A fistula-in-ano is the infected channel between the anal canal and rectum with the perianal (exterior) skin.
The key difference between piles and fistula is the latter induces pain and pus discharge from the anal area, whilst the former is usually painless.
A fistula occurs due to persistent anal gland infection, which results in anorectal abscesses – when the anal or the rectum cavity is filled with pus.
Since the anal has multiple openings, treatment of one fistula does not guarantee the impossibility of spread to the rest of the areas.
In India, tuberculosis is a widespread disease. Patients suffering from pulmonary tuberculosis are at risk of developing multiple anal fistulae. These fistulae are not hard but experience watery discharge without pus and this is a key reason why it is important to know the difference between piles and fistula.
Health Conditions That Cause Anal Fistula
Usually, a fistula is identified as an external opening in the anal cavity. It can be identified by four signs:
Depending upon the complexity, the following methods can be used to identify the fistulas or determine the severity of the condition:
Methods 2 and 3 can be decided to use for special cases. Some of these examinations are conducted with regional anaesthesia.
Being aware of the difference between Piles and Fistula and Fissure makes us understand, that when compared to piles, the treatment for fistulas can only be done through surgery.
Depending upon the complexity of the condition, the following lines of treatment for fistula are recommended:
In this procedure, a probe is inserted through the external opening into the rectum and along the track where the fistula is open. The wound is left open and left to heal with the natural formation of granulation tissues. Intersphincteric (found in the space between internal and external anal sphincters) and low transsphincteric fistulas of recent origins can be treated by this method.
The advantages are:
There are two kinds of fistulectomy:
This is a new method of treatment that includes a two-step process:
First, it closes the internal opening of the fistula. Then, fibrin glue is injected in the tunnel that the body eventually absorbs with time.
LIFT is primarily performed for complex and deep fistulas. It enables the surgeon to access the fistula between the sphincter muscles to avoid cutting them.
A seton is placed into the fistula tract to widen the gap with time. After a few weeks, the surgeon removes the infected tissue and closes the internal fistula opening.
A quicker method (done in approximately 30 minutes) to treating fistulas in India has been introduced.
In this laser treatments for fistulas, a laser fibre, with a set amount of laser energy is inserted from the external opening. It causes controlled destruction of the internal nodes by reducing the blood supply nourishing the abnormal growth.
Chances of reoccurrence are low with this route of treatment.
– An anal fistula is an infected channel between the anus and its surrounding skin. It is the result of persistent anal gland infection.
– Usually, it is diagnosed with a physical examination. However, the doctor may prescribe digital methodologies, depending upon the complexity of the situation.
– There is only one route of treatment for fistulas: surgery. In India, laser surgeries are rising in demand.
Consult your city’s top general doctors for expert care and fistula treatment plans
An anal fissure is characterised by a longitudinal tear in the mucosa (tissue) that lines the anus. It starts by passing hard stools that cause a crack. This is the most painful condition, commonly observed amongst the young population.
90% of anal fissures occur in the posterior part of the anal canal. The remaining 10% occur in the front.
Anterior fissures are commonly noticed in women subjected to multiple vaginal deliveries. The reason? A damaged pelvic floor and lack of support to the anal mucous membrane.
A physical rectal examination can reveal the state of the tear and a hypertrophied i.e. thickened skin near the lower end of the fissure.
Depending upon the severity, further tests are recommended:
The difference between piles and fistula and fissure is that a fissure is the tearing of the anus lining whereas a fistula is an abnormal connection between the anus and the skin. This brings us to a clear understanding of the difference between Piles and Fistula and Fissure. Now we shall look at the methods of treatment for fissure.
In this procedure, the internal sphincter is divided away from the fissure. LIS has a high success rate and should be limited to the length of the fissure to avoid incontinence.
To treat persisting, chronic and non-healing fissures, the defect remaining after the excision of the fissure is closed by a small rhomboid advancement flap.
The recovery takes longer as compared to other kinds of treatment for fissure. It is advisable not to consider this as the first line of solution.
– A fissure is a noticeable cut in the lining of the anus. It leads to terrible pain during defecation.
– 90% of the fissures affect the posterior of the anal canal.
– Usually, fissures can be cured at home by resorting to home remedies and laxatives. Very few cases require surgery.
Consult top general physicians on MFine to know more about Anal fissure, its symptoms, and how to figure out the difference between piles and fistula and fissure.
The critical difference between Piles and Fistula and Fissure is:
Piles affect the blood vessels inside the anal canal.
Fistula is an abnormal tunnel between the anus and the surrounding skin.
A fissure is a visibly painful crack on the lining of the anus tissue.
The symptoms and causes of piles, fistulas, and fissures help differentiate (and diagnose) these conditions accurately. The table below highlights the differentiating criteria:
– Based on their symptoms and causes, piles, anal fistulas, and fissures are distinctly different from each other.
– To avoid these diseases, patients must maintain a healthy lifestyle that entails a fibre-rich diet, good liquid intake, and regular exercise.
Consult your city’s top general physicians on MFine for an accurate diagnosis of your condition
Piles, Fistula, and Fissures are serious conditions. To acquire a good understanding of the difference between piles and fistula and fissures, read this set of the most Frequently Asked Questions below:
Q1. Do men and women suffer from haemorrhoids at the same rate?
Haemorrhoids affect both genders at the same rate. The risk is higher for adults between 45-65 years of age. Despite this widespread incidence, only 4% of the infected experience severe problems due to enlarged haemorrhoids.
Q2. How many pregnant women suffer from piles in India?
Pregnant women can experience piles due to an enlarged uterus or weaker muscles, a typical result of hormonal changes. It is found that 1 in every 10 expected mothers suffer from piles in India.
Q3. How do doctors diagnose piles?
Depending on the patient’s symptoms, a physician can diagnose piles with a visual examination of the anus. A physical test is the first (and most frequently) used procedure. Here, the doctor inserts a lubricated finger into the rectum to check for abnormalities.
To check for internal haemorrhoids, doctors prefer using the Proctoscopy methodology. Here, a device is inserted inside the rectum. The light on the lens gives a good view to make an informed diagnosis.
In some cases, a small fibre optic-camera, also known as sigmoidoscopy, is inserted into the rectum.
Q4. What are the chances of reoccurrence after surgery?
Usually, surgery cures piles. But the chances of reoccurrence depends on how well does a patient take care post-surgery. It is vital to maintain a fibre-rich diet along with hydrating the body.
Once healed, it is recommended to keep the body weight in check. Yoga is the best exercise to help a person remain healthy (physically and mentally).
Q5. What happens if piles is left untreated?
It is essential to treat piles at the earliest. If untreated, the internal haemorrhoids can stick out – leading to irritation, rashes, bleeding, and other severe complications during excretion.
Q6. Which other factors lead to stool bleeding?
Stool bleeding is not limited to haemorrhoids. It may also be due to:
Q1. Which bacteria is most commonly associated with anal gland infection?
Common anal abscess causative bacteria include E.Coli, Bacteroides spp, and Enterococcus spp.
Q2. Does an abscess always convert into a fistula?
50% of abscess cases convert into a fistula. Thus, if you have an abscess, you might not necessarily develop a fistula.
Q3. Which other organs are susceptible to develop a fistula?
Fistulas can occur between different parts of the body. Some of them are:
Q4. Can an abscess or fistula recur?
There’s a good chance that a fistula will recur. Since the anal has multiple glands, it is recommended to prevent the symptoms by maintaining healthy hygiene habits and following a fibre-rich diet.
Q5. Is the operation painful?
The surgical treatment for the fistula depends upon its location and complexity in the body. If the operation is simple, chances are you can return home the same day. With complicated surgeries, the patient needs to stay at the hospital to get proper medical attention.
Some discomfort can be experienced post-surgery. However, it is short-lived. Proper medical attention and healthy habits speed-up the recovery timeline.
Q6. What precautions should be taken post-surgery to prevent recurrence?
It is natural to experience some pain and bleeding after surgery. However, it is important to rest well for at least 24 hours post-surgery.
If discharged immediately, follow the guidelines as suggested by your doctor to keep the wound clean and packed. A healthy diet, good liquid intake, and a temporary break from exercise are recommended.
Q1. What should be done to treat chronic constipation?
Constipation is the most common cause of fissures. Therefore, it is essential to cure them at the earliest. Some effective remedies are:
Further, on your doctor’s recommendation, it is ideal to consume bulk-forming agents like methylcellulose, stool softeners like docusate, osmotic laxatives such as Milk of Magnesia, and lubricant laxatives like mineral oil.
Q2. What is a Sitz Bath?
Sitz, meaning to sit, refers to a kind of bath that involves sitting on a bathtub filled with warm water. Add salt to the water and spread your legs for the water to touch your genitals. Regularly conducting sitz bath for one week should help heal the initial anal tear.
Q3. How many cases of fissure require surgery?
Most of the anal fissure cases heal on their own. Eating fibre-rich food, taking sitz baths, and applying anaesthetic creams should help fix the tear. Very few cases require surgery in India.
Q4. How long does a fissure take to heal without surgery?
Short-term anal fissures typically heal between 4-6 weeks without operations. When home-remedies are implemented regularly, the patient will be freed from the pain.
Q5. How does a fibre-rich diet treat constipation?
Soluble and insoluble fibre is vital for the human body. Soluble fibre (apple, oranges, carrots, etc.) allows water to remain in the stool; thereby, smoothening the digestive tract.
Insoluble fibre (brown rice, nuts, lentils, etc.) adds bulk to the faecal material that allows quick movement of the stool outside the body, thereby reducing the constipation feelings.
Q6. Do fissures recur?
Yes. There are good chances for fissures to recur if an individual develops constipation or any other inflammatory disease.
In order to prevent this recurrence, it is imperative to maintain a healthy lifestyle.
Piles, anal fistula, and fissures affect the anal canal. However, this commonality should not be mistaken as a single disease. Each of these diseases affects the human body in different sub-locations and with varying intensities.
It is important to carefully analyse every symptom and accordingly seek medical assistance. If you’re suffering from piles, anal fistula, or fissures, consult your doctor immediately, and things will soon be back to normal.
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