Fissure vs. Haemorrhoid: How to Tell the Difference

First Up: What Are Haemorrhoids?

Haemorrhoids are actually a normal part of anatomy - everyone has them. They are blood vessel cushions in the anal canal. We use the term "haemorrhoids" when they become enlarged, inflamed, and symptomatic. Causes include straining, long toilet time, pregnancy, and low-fibre diet. Note that haemorrhoids are extremely common and nothing to be embarrassed about.

And What Is an Anal Fissure?

A fissure is a tear in the lining of the anal canal - not a vascular issue like haemorrhoids, but a structural one.

The Key Difference: Pain

The single most useful question to ask yourself:

Painful bleeding = fissure. Pain during or after a bowel movement, with bright red blood, almost always indicates a fissure.
Painless bleeding = haemorrhoids. Blood without pain is the classic haemorrhoid presentation.
Both at once = possible. If you have pain sometimes and not others, or notice bleeding in different circumstances, both conditions may be present simultaneously. This is not uncommon, particularly in people who have chronic constipation.

Note: any rectal bleeding should be assessed by a doctor if it is new, persistent, or accompanied by other symptoms like changes in bowel habits or unexplained weight loss. This article is not a substitute for a proper examination.

Other Ways to Tell Them Apart

	Anal fissure	Haemorrhoid
Sensation	Sharp, tearing pain	Dull ache, pressure, or itchiness
Timing	Peaks during and immediately after a bowel movement, then lingers	More constant, or triggered by sitting
Appearance	May show a small skin tag (sentinel tag) in chronic cases	External haemorrhoids may be visible as a soft lump near the anal opening
Blood colour	Both typically produce bright red blood. Dark or tarry blood suggests something higher up in the gut and needs urgent medical attention.

Can You Have Both at Once?

Yes - and it is more common than people realise, especially in anyone dealing with chronic constipation.

Straining that causes haemorrhoids can also cause fissures. Treat this section practically: if you are unsure which one you have, that is reason enough to see a doctor rather than self-diagnose and potentially treat the wrong thing.

What Helps Each One?

For fissures: barrier ointments, warm soaks, dietary fibre, reduced toilet time, prescription antispasmodics if needed. Link to full fissure article.
For haemorrhoids: increased fibre (psyllium husk shown to reduce recurrence by 50%), limit toilet time, avoid straining, topical creams for comfort, procedures if severe.

When to See a Doctor

Do not wait if: bleeding is heavy, new, or not improving. You have both conditions and are unsure which is driving symptoms; there is swelling, discharge, or fever; or symptoms have lasted more than a few weeks without improvement.

Want to hear it straight from the surgeon?

This article is based on our interview with Dr. Hamish Urquhart on The Hole Conversation, the Happie Holl podcast. Tune in to hear the full conversation - including the bits that did not make it into print.

Listen now at happieholl.com.au or search "The Hole Conversation" wherever you get your podcasts.