Anal Fissures vs Anal Fistulae: Understanding the Pain Down There — Causes, Symptoms, and When to See a Doctor

Rectal pain and discomfort is one of those health issues many people hesitate to talk about — yet conditions like anal fissures and anal fistulae are more common than most realize. If you're experiencing pain, bleeding, or discharge around the anus, it may be a sign of one of these two conditions.

In this article, we’ll explain the difference between anal fissures and anal fistulae, their causes, symptoms, and treatment options — simplified to help you understand when it’s time to seek medical help.

🔍 What Is an Anal Fissure?

An anal fissure is a small tear or crack in the skin lining the anal canal. This can happen during a difficult bowel movement, especially when passing hard or large stools. It’s a common condition in both adults and children and often results from constipation or straining during defecation.

Common Anal Fissure Symptoms:

• Sharp, burning pain during or after bowel movements

• Bright red blood on toilet paper or stool

• A visible crack or cut near the anus

• Itching, irritation, or a feeling of tightness in the anal area

Fissures can be acute (short-term) or chronic (long-term). Chronic fissures may not heal on their own and might require medical or surgical intervention.

Image of anal fissure- a skin laceration around the anal area

What Is an Anal Fistula?

An anal fistula is a small tunnel or tract that forms between the inside of the anal canal and the skin around the anus. It often develops after an anal abscess — a painful collection of pus — drains or bursts but leaves a channel behind. Unlike fissures, fistulae rarely heal without surgical treatment.

Common Anal Fistula Symptoms:

• Persistent pain or throbbing near the anus

• Pus or blood draining from a small opening near the anus

• Skin irritation or itching

• Recurring abscesses or swelling

• Fever or fatigue if infection is present

Anal fistulae are more complex than fissures and may involve deeper tissues or even muscle layers.

Image of anal fistula- probe has passed through it into anal canal

What Causes Anal Fissures and Fistulae?

✅ Common Causes of Anal Fissures:

• Chronic constipation or diarrhea

• Straining during bowel movements

• Childbirth trauma

• Inflammatory bowel diseases like Crohn’s disease

• Anal intercourse or local trauma

✅ Common Causes of Anal Fistulae:

• Previous anal abscesses

• Crohn’s disease or other chronic inflammation

• Sexually transmitted infections

• Tuberculosis or HIV (in rare cases)

• Post-surgical or traumatic injury to the anal area

🩺 Treatment Options for Anal Fissures and Fistulae

Anal Fissure Treatment:

Most fissures heal with non-invasive care:

• Increase fiber and fluids to soften stools

• Use stool softeners or mild laxatives

• Apply topical ointments (e.g., nitroglycerin or diltiazem) to relax anal muscles

• Take warm sitz baths several times daily

If a fissure doesn’t heal after 6–8 weeks, surgical options like a lateral internal sphincterotomy may be recommended to reduce muscle spasm and promote healing.

Anal Fistula Treatment:

Fistulae typically require surgery for a complete cure:

• Fistulotomy: Opening the fistula tract for it to heal from the inside

• Seton placement: A surgical thread placed to allow drainage and promote healing

• Advancement flap or LIFT procedure: Used in complex cases to avoid damage to the anal sphincter

Prompt treatment helps prevent infection, chronic discomfort, and complications like incontinence.

When to See a Doctor for Anal Pain

If you're experiencing:

• Ongoing pain during or after bowel movements

• Bleeding from the rectum

• Pus or discharge from the anal area

• Fever with rectal pain

• Recurring abscesses or swelling

...it's time to consult a healthcare professional. Early treatment can significantly improve outcomes and relieve symptoms before they worsen.

📝 Final Thoughts: Don’t Suffer in Silence

Though anal fissures and anal fistulae may feel like embarrassing topics, they are both common, treatable medical conditions. There’s no need to suffer silently. The sooner you get evaluated, the sooner you can get relief — and reclaim your comfort and peace of mind.

🔍 Frequently Searched Questions:

1. Are anal fissures and fistulae the same thing?No. A fissure is a tear in the skin, while a fistula is a tunnel formed by infection.

2. Can anal fissures heal on their own?Yes, most acute fissures heal with home care, but chronic fissures may need treatment.

3. Do fistulae always require surgery?In most cases, yes. Conservative measures usually do not close a fistula completely.

4. Is rectal bleeding always serious?Not always, but persistent or heavy bleeding should always be evaluated by a doctor.

🩺 Need Help?

If you're experiencing anal pain, bleeding, or unusual discharge, don’t wait. Speak to a doctor, gastroenterologist, or colorectal surgeon for a proper evaluation and treatment plan.