Piles and fissure

1. Definition

Piles (Hemorrhoids):

Abnormal dilatation and engorgement of the veins in the anal canal, usually involving the internal hemorrhoidal plexus or external hemorrhoidal plexus.

Anal Fissure:

A linear tear or ulcer in the anal mucosa, usually in the posterior midline of the anal canal.

2. Causes / Etiology

Factor Piles (Hemorrhoids) Anal Fissure

Mechanical stress Chronic constipation/straining during defecation Hard stool passage causing mucosal tear

Venous pressure Increased intra-abdominal pressure (pregnancy, obesity, lifting heavy weights) 

Vascular changes Weakening of venous walls or supportive connective tissue 

Other factors Sedentary lifestyle, low fiber diet, liver disease causing portal hypertension Chronic diarrhea, inflammatory bowel disease, anal trauma

3. Pathology / Pathophysiology

Aspect Piles Anal Fissure

Primary lesion Dilated, tortuous veins in anal canal Tear or ulcer of anal mucosa

Location Internal: above dentate line; External: below dentate line Usually posterior midline (common), anterior in females

Tissue involved Venous plexus, submucosa, sometimes skin Mucosa and submucosa; rarely sphincter muscle

Complications Thrombosis, bleeding, prolapse, anemia Chronic fissure → fibrosis, sentinel pile, spasm of internal sphincter

4. Clinical Features (Quick Differentiation)

Feature Piles Anal Fissure

Piles pain Usually painless (internal) Severe, sharp pain during/after defecation

fissures bleeding Bright red blood on stool or toilet paper Bright red bleeding, often streaked on stool

Piles -Prolapse May prolapse outside anus (internal piles) Not typical, but chronic fissure may have sentinel tag

Onset Gradual Often sudden after passing hard stool

Itching/Discharge Sometimes Rare

5. Summary of Key Differences

Piles: Vascular pathology → dilated veins → may bleed or prolapse; generally painless.

Fissure: Mechanical mucosal injury → tear → very painful, especially during defecation.