Answers
Piles, fissure or fistula: what is the difference?
Short answer
Piles are swollen veins in the back passage that often bleed painlessly. A fissure is a small tear that causes sharp pain during and after passing stool. A fistula is a small tunnel from inside the back passage to the skin that leaks pus. All three are common, but bleeding from the back passage should be checked to rule out other causes.
How to tell them apart
- Piles: bright red blood dripping or on the paper, usually without pain; sometimes a lump that comes out and goes back
- Fissure: sharp, cutting pain while passing stool and for hours afterwards, often with a streak of blood; usually linked to hard stools
- Fistula: a painful swelling or boil near the anus that bursts, followed by repeated pus or discharge from a small opening on the skin
Home care that helps piles and fissures
- Soft stools: more fibre (fruits, vegetables, whole grains, isabgol) and enough water
- Do not strain or sit on the toilet for long, including with a phone
- Warm water sitz baths for 10 to 15 minutes, two or three times a day
- Go when you feel the urge, without delay
Treatment
- Piles: creams for short-term relief; rubber band ligation, a quick clinic procedure, for bleeding piles that do not settle; surgery for large piles
- Fissure: stool softening and medicated ointments heal most fissures in a few weeks; long-standing fissures may need further treatment
- Fistula: usually needs surgery, as it rarely heals on its own
When to see a doctor
See a doctor for any bleeding from the back passage that is new, keeps coming back, or comes with a change in bowel habit, weight loss, anaemia or a family history of bowel cancer, especially after age 45. Do not assume it is piles; a colonoscopy may be needed. Heavy bleeding, fever with a painful swelling, or dizziness needs urgent care.
Diet for soft, easy stools
Eat more
- Fruits such as papaya, guava, pear and orange, and vegetables at every meal
- Whole grains: atta with chokar, dalia, oats, brown rice
- Isabgol in water or curd, and 8 to 10 glasses of water a day
Cut down
- Maida, bakery items and fast food that harden stools
- Too much tea or coffee and alcohol, which dry you out
- Very spicy food if it makes a fissure sting
Good to know
- Spicy food does not cause piles, but soft stools are the key to healing them.
- Increase fibre slowly over two weeks to avoid gas.
Common questions
Can piles turn into cancer?
No. But bowel cancer can also bleed, so new or repeated bleeding, especially after 45 or with weight loss or anaemia, should be checked.
Can a fissure heal without surgery?
Most new fissures heal within a few weeks with soft stools, sitz baths and ointment. Long-standing fissures sometimes need further treatment.
Is rubber band ligation painful?
It is done in the clinic without anaesthesia. Most people feel a dull ache or pressure for a day or two and return to work quickly.