The patients in Minnesota often couldn’t tell the differences between anal fissure and hemorrhoids because they both cause rectal pain and rectal bleeding at the same location. Although both hemorrhoids and anal fissure are associated with similar symptoms, they are two very different diseases that are important to distinguish.
Hemorrhoids could be as painful as anal fissure when thrombosis develops. In the most time, the pain caused by hemorrhoids is mild, persistent, dull aching pain, not always related to bowel movement. Anal fissure usually has sharp rectal pain during bowel movements.
An anal fissure is a tear in the anal canal in the lower rectum. Anal fissures are typically thought to be caused by trauma from a hard or painful bowel movement. Many patients report bright red blood on the toilet paper or the stool, though bleeding is usually not significant.
If hemorrhoids and anal fissures occur together, the patients have to treat anal fissure first. Not only is anal fissure more painful, but also is hemorrhoids usually treated under anoscope which creates more pain and makes anal fissure worse.
Hemorrhoids and anal fissures are initially treated with high fiber diet (such as fruits, veggies and whole grains) , taking an over-the-counter stool softener and using creams or ointments especially for hemorrhoids. It can also help to soak your bottom in warm water for 2-3 times a day, and Sitz baths after bowel movements are effective in relieving symptoms.
If these first-line treatments do not work, the patient will focus on the definitive treatments for anal fissure with the topical agents such as Nifedipine and nitroglycerine (NTG) ointment in conjunction the treatments listed above.
Botox has also shown to be a promising treatment, its relaxation effect on sphincters lasts for three months that is long enough for anal fissure to heal. If the anal fissure does not resolve following treatments, then a partial anal sphincterotomy may be needed, where a cut will be made on the anal sphincter in a different location in the anus, and both the fissure and new cut will heal together.
After anal fissure heals, the attention turns to treat the hemorrhoids with infra-red coagulation, banding or surgery if necessary.