The short answer
An anal fissure is a small tear in the skin of the back passage: it causes sharp, tearing pain during a bowel movement that can last for an hour or more afterwards, with a little bright red blood. Piles are swollen blood vessels that more often cause painless bleeding, itching or a soft lump. The two need different treatment, so it is worth being examined rather than guessing.
See a general surgeon in LagosMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
The main differences
- Pain: fissure is sharp, like passing glass, and burns for a long time after; piles are often painless, or ache
- Blood: both cause bright red blood on the tissue or in the toilet; piles more often drip blood
- Lump: piles may give a soft lump that comes out with straining; a fissure may have a small skin tag at its edge
- Itching and mucus: more typical of piles
- Fear of the toilet: very typical of fissure, because of the pain
Why fissures happen and why they linger
A fissure usually starts with passing a hard, large stool, though long-term diarrhoea can also cause one, and it is common after childbirth. The pain makes the muscle ring around the anus go into spasm, which reduces blood flow and stops the tear healing. People then avoid the toilet, the stool gets harder, and the cycle continues.
Treating a fissure
Most fissures heal within a few weeks with soft stools: water, fibre, a bulk-forming laxative, and warm sitz baths. A local anaesthetic gel before motions helps. If it has not healed after a few weeks, a doctor may prescribe an ointment that relaxes the muscle, such as glyceryl trinitrate or diltiazem, used for several weeks.
For a fissure that will not heal, options include a botulinum toxin injection or a small operation called lateral internal sphincterotomy, which relaxes the muscle. Your surgeon will explain the benefits and the small risk to bowel control before you decide.
Treating piles
Piles also improve with soft stools and not straining. Persistent piles may need banding in clinic, and larger ones an operation. Our guide to whether you need surgery for piles covers the steps in order.
See a doctor promptly if
- You are over about 50 with new bleeding from the back passage
- The blood is dark, or mixed in with the stool
- Your bowel habit has changed for more than a few weeks
- You are losing weight, feel very tired, or there is bowel cancer in the family
- There is a hard lump, pus, fever, or pain that is getting worse
What it costs on Mezo
Day case. Home the same day.
Common questions
Can I have both a fissure and piles at the same time?
Yes, it is common. A doctor's examination sorts out which is causing which symptom, and the treatment plan covers both.
Does jedi-jedi medicine cure a fissure?
No. Strong herbal purgatives can cause diarrhoea, which can itself irritate a fissure. Soft, regular stools and the right ointment are what help it heal.
Will a fissure need an operation?
Usually not. Most heal with simple measures and ointment. Surgery is for the minority that do not heal after these.
Who should I see on Mezo?
A general or colorectal surgeon. Book through the haemorrhoid surgery page and say you want an assessment for pain or bleeding from the back passage; the surgeon will decide what is needed, which may be no operation at all.
The procedures
Related health guides
More patient guides
Sources and further reading
The guidelines and patient information this page is checked against. Care in Nigeria follows the same evidence; what differs is the price and where it is done.
- Anal fissure. NHS. Patient information.
- Piles (haemorrhoids). NHS. Patient information.
Links last checked 22 October 2026.
Medical disclaimer: This guide is general information and does not replace advice from your own doctor. Where your centre's instructions differ from this guide, follow theirs.