What Is the Difference Between Hemorrhoids and Anal Fissures?

The biggest difference is what is causing the symptoms:

• An anal fissure is a small tear in the lining of the anal canal.
• An internal hemorrhoid is a swollen blood vessel inside the rectum.
• An external hemorrhoid is a swollen blood vessel under the skin around the anus.

Although all three conditions can cause discomfort and bleeding, they often feel very different.

Anal fissures typically cause sharp pain during bowel movements.

Internal hemorrhoids often cause painless rectal bleeding, itching, or tissue that protrudes from the anus (prolapse).

External hemorrhoids are more likely to cause pain, swelling, tenderness, or a noticeable lump near the anus.

Anal Fissure vs. Internal Hemorrhoids: At a Glance

Although both conditions can lead to bright red blood on toilet tissue or in the toilet bowl, the timing, duration, and specific type of the pain provide key diagnostic clues.

Understanding Hemorrhoidal Disease

Hemorrhoids are swollen blood vessels in or around the rectum and anus. They can develop when increased pressure causes these vessels to stretch and enlarge.

Common Causes of Hemorrhoids

• Chronic constipation and straining during bowel movements
• Sitting on the toilet for long periods
• Heavy lifting
• Pregnancy
• Excess body weight

Types of Hemorrhoids

Hemorrhoids are categorized as either internal or external depending on their location. While both can cause discomfort, internal hemorrhoids are the type most commonly associated with rectal bleeding and may be treated with minimally invasive procedures such as Hemorrhoid Artery Embolization (HAE).

Internal Hemorrhoids

Internal Hemorrhoids develop inside the rectum above the dentate line. Because this region lacks visceral pain-sensing nerve fibers, internal hemorrhoids are typically painless. Their primary indicator is bright red blood during defecation. Common symptoms include:

• Bright red rectal bleeding
• Itching or irritation
• Mucus discharge
• A feeling of fullness or pressure
• Prolapse, or tissue that extends outside the anus

External Hemorrhoids

External hemorrhoids develop beneath the skin surrounding the outer anal canal below the dentate line. These tissues are densely innervated, causing swelling, persistent aching, itching, or painful palpable lumps.

Common symptoms include:

• Pain or tenderness
• Swelling
• Itching
• A lump near the anus
• Severe pain if a blood clot develops (thrombosed hemorrhoid)

Understanding Anal Fissures

An anal fissure is a small, linear cut or tear in the specialized skin lining the anal canal. The tear exposes the underlying internal anal sphincter muscle, triggering painful muscle spasms and increased tissue tension.

Common Causes of Anal Fissures

• Passing large, dry, or abnormally hard bowel movements.
• Chronic or severe diarrhea.
• Elevated baseline resting pressure in the anal sphincter muscles.
• Local trauma resulting from childbirth or anal intercourse.

Can Hemorrhoids and Fissures Develop at the Same Time?

It is relatively common for a patient to have both an anal fissure and hemorrhoids simultaneously.

Since both conditions share common predisposing factors such as chronic constipation and straining, one condition can exacerbate the formation of the other. When an anal fissure occurs, the extreme pain triggers involuntary contractions (spasms) of the internal anal sphincter muscle. These continuous muscle spasms restrict localized blood flow, impeding tissue healing while elevating pelvic tissue pressure, which can worsen underlying hemorrhoidal veins.

Advanced Non-Surgical Treatment: Hemorrhoid Artery Embolization (HAE)

While traditional management often moves from conservative care directly to invasive surgical procedures, interventional radiologists (IRs) provide advanced, minimally invasive solutions.

At USA Hemorrhoid Centers, interventional radiologists specialize in Hemorrhoid Artery Embolization (HAE) for symptomatic internal hemorrhoids.

• Minimally Invasive: Using image guidance and a tiny catheter, the physician blocks selected arteries that supply blood to the internal hemorrhoids. Reducing blood flow helps the hemorrhoids shrink and relieves symptoms over time.
• Reduced Post-Procedure Pain: Because HAE works without excision or incision of rectal tissue, patient discomfort is substantially lower compared to surgical hemorrhoidectomy or rubber band ligation.
• Outpatient Convenience: Completed in an outpatient setting with minimal recovery downtime, allowing a prompt return to normal activity.

When Patients Should Seek Medical Evaluation

Patients should consult a specialist if they experience any of the following clinical indicators:

• Rectal bleeding or pain that persists for longer than seven days despite conservative care.
• Large, painful, or worsening lumps around the anal opening.
• Dark red, maroon, or black blood in the stool.
• Dizziness, systemic fatigue, or severe pain that interferes with daily activities.

Accurate clinical evaluation is essential to rule out other gastrointestinal conditions and establish an individualized treatment plan.

Accessing Care at USA Hemorrhoid Centers

Unresolved anorectal symptoms do not have to impact long-term quality of life. Interventional radiologists at USA Hemorrhoid Centers perform comprehensive evaluations and offer non-surgical treatment options designed to provide effective relief.

Consultations and non-surgical procedures are available at clinic locations nationwide, with most major insurance plans accepted.