Do I Have a Hemorrhoid or Anal Fissure?
It can be hard to tell if you have hemorrhoids or an anal fissure. Both can cause pain during bowel movements and produce bright red blood during and after using the bathroom.
If your pain is severe during bowel movements, you most likely have an anal fissure, which is a tear in the tissue that lines your anus.
To get a better look and to self-diagnose what is causing your discomfort, use a hand mirror to look at your anus. Find a room with good lighting and squat down while holding the mirror under you or lay on your back with your knees up. You can also use your phone to take a photo and then zoom in for an extra close-up view.
If you can not see anything, gently touch your anus to get an idea of where the pain or discomfort is coming from. Wear gloves, a finger cot, or wash your hands really well before and after.
What Do Hemorrhoids Look Like?
Image courtesy S Bhimji MD. From: Internal Hemorrhoid Copyright © 2022, StatPearls Publishing LLC
Hemorrhoids are swollen veins inside or outside your anal canal. Although they may protrude out of your anus during a bowel movement, internal hemorrhoids usually remain inside your anal canal. They are not likely to be painful.
External hemorrhoids are on the outside of your anus and look like pink or purplish lumps. These are more painful and uncomfortable than internal hemorrhoids because they are surrounded by many nerves.
External hemorrhoids that have healed may look like skin tags because the hemorrhoid has stretched the skin. If their appearance bothers you, ask your healthcare provider about getting it removed.
What Do Anal Fissures Look Like?
Acute (sudden) anal fissures look like small papercuts. Chronic (long-term) anal fissures are longer, deeper tears and can indicate other underlying health conditions.
If you do not see or feel a lump around your anus and you are feeling pain, you most likely have an anal fissure.
Can I Have Both a Hemorrhoid and Anal Fissure?
Straining during bowel movements and constipation can cause hemorrhoids and/or anal fissures so it is possible to have both of these bowel disorders at the same time. We recommend you take a look at your anus with a mirror or your phone to get a better idea of what is causing you discomfort. If you think you have both hemorrhoids and anal fissures, treatment is similar for both.
Ask a Healthcare Provider
Dr. Carmen Fong, a colorectal surgeon in NYC. Follow her instagram for helpful tips: @drcarmenfong
For a proper diagnosis, a healthcare provider can examine your anus. This can be done by your primary care provider, a pelvic floor physical therapist, a colorectal surgeon, or a gastroenterologist.
A physical exam usually includes you getting undressed from the waist down, then “people tend to have three different positions for the rectal exam — lithotomy (on their back, legs up), on their side with knees bent or on their knees and bent over,” says Dr. Carmen Fong, a colorectal surgeon based in New York City.
Your healthcare provider will look at your anus and if they need more information, they may feel the outside and inside of your anus with a gloved finger or use an instrument like an anoscope to look inside. They will insert an inch or less of their finger or medical tool.
Your healthcare provider should ask for your permission before every step of the physical exam. If you feel uncomfortable for any reason, you can stop the exam. You can also ask to have someone else in the room with you, like a friend, family member, or nurse.
Relief and Treatment
Treatment for anal fissures and hemorrhoids are very similar so even if you can not figure out whether you have hemorrhoids or a fissure, these remedies will give you relief for both:
Sitz bath
High-fiber diet
Hydrate
Go when you feel the urge
Do not strain
Exercise
View a full list of hemorrhoid remedies.
View our full list of anal fissure remedies.
If you do not see relief from hemorrhoids within a few days or from an anal fissure within eight weeks, get an appointment with your healthcare provider. Delayed healing could indicate other health issues.
Citations
https://www.hopkinsmedicine.org/health/conditions-and-diseases/anal-fissures
https://www.mayoclinic.org/diseases-conditions/hemorrhoids/diagnosis-treatment/drc-20360280
https://www.ucsfhealth.org/education/hemorrhoids
https://lacolon.com/article/can-i-have-hemorrhoids-fissure-same-time
https://www.rainn.org/articles/sexual-abuse-medical-professionals
