How can I differentiate between anal fissures and haemorrhoids?

Haemorrhoids are found in the upper anal canal where there are no nerves that sense pain. Anal fissures occur at the outer edge of the anus which senses sharp pain. Therefore, anal fissures tend to cause sharp pain when you pass stools. It tend to cause painless fresh bleeding when you pass stools.

Sometimes, it is difficult to differentiate the two conditions because both can cause fresh bleeding during the passage of stools.

Anal fissures will usually cause pain and the amount of bleeding is small (seen as streaks of blood when wiping the anus with toilet tissue). Haemorrhoids tend to cause more bleeding, which may be seen on toilet tissue or even drips into the toilet bowl.

Some patients with haemorrhoids may feel a lump protrude out of the anus when they clean the anus.

The two conditions are clinically different. For a haemorrhoid, you will expect a soft swelling at the anal region. The haemorrhoid may be tender if it is acutely thrombosed. A thrombosed haemorrhoid will appear as a lump, protruding from the anus. It is usually dark blue as the blood vessels are swollen.

Haemorrhoid swelling happens due to an increase in pressure in vessels, therefore causes it to increase in size. Haemorrhoids lasts for a couple of days and recur frequently.

Meanwhile for a fissure, you may just feel a skin tag. The fissure is always tender. These fissures are tears of the mucosal lining of the rectum. It causes pain during and/or after your bowel movement. Often, it also accompanies with a throbbing pain.