Disease at a Glance: Piles, Anal Fissure & Fistula

Piles or haemorrhoids occur where the veins in our rectum and anus are swollen and engorged with blood as a result of intra-abdominal pressure. This happens because of excessive straining while passing stool due to prolonged constipation (thanks to a low-fibre diet). Piles are also common during pregnancy, particularly in the 3rd trimester, because of pressure exerted by the growing uterus on the veins below.


Piles are of two types – external and internal – depending on where they are located. While internal piles occur inside the anus (2-4 cm above the anal opening), external piles develop further down (near the outside edge of the anus). Typically, external piles are more painful but there’s very little bleeding. Internal piles, on the other hand, are less painful but there’s lot more bleeding.


Common Symptoms

Itchiness and swelling in the anal region
Sudden appearance of a lump near the anus that is sensitive or painful
Bleeding during bowel movements
Pain or ache in the anal region, especially while sitting
A bloated feeling even after passing stool


Piles can be mildly uncomfortable to downright painful. Symptoms vary from person to person, but may include some the following: itchiness and swelling in the anal region; sudden appearance of a lump near the anus that is sensitive or painful; bleeding during bowel movements; pain or ache in the anal region, especially while sitting; a bloated feeling even after passing stool, etc.


Bear in mind that not all rectal bleedings occur due to piles. It may also be on account of ulcer, inflammation of the colon or rectal/anal cancer. A physical examination by your doctor is necessary to rule out any serious condition. Rule of thumb is that if the blood is fresh blood, its piles. Black stool, blood clots or stool mixed with blood usually signal a more serious condition.


In most cases, piles resolve on their own and do no need any treatment. However, your doctor may prescribe an over-the-counter ointment for symptomatic relief and stool softeners to avoid straining. You may also be advised to drink plenty of water and change your diet. A sitz bath or soaking your anal area in warm water for 10-15 minutes, 2-3 times a day, is also advised. More serious conditions may require surgical intervention.


In piles, prevention is very important. Avoid constipation by increasing your daily water intake and eating a high-fibre diet. Do not strain while passing stool and go as soon as you feel the urge.


Anal fissure and fistula are often confused with piles. But there are significant differences. Anal fissure is a tear in the thin lining of the anus. It can be cause severe pain during bowel movements and is usually accompanied by bleeding that can last for quite some time afterwards. The good news is that anal fissures usually heal on their own.


Anal fistula occurs when a small channel develops between one of the small glands inside the anus and the skin near the anal opening – these two normally do not connect. This usually occurs as a result of an anal abscess. Although symptomatic management may provide temporary relief, surgery is the only curative treatment for anal fistula.



1. Mayo Clinic (

2. US National Library of Medicine (

3. Harvard Medical School (

4. Cleveland Clinic (


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