Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPreventionFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prevention
Frequently Asked Questions
Though they may have similar symptoms in some cases,anal fissuresandfistulasare different conditions. An anal fissure is a crack or a tear in the tissue of the anus. A fistula is when a tunnel or connection forms between two organs or the organ and the skin.
Fissures and fistulas can both cause pain and bleeding. However, they are treated differently, so it’s important to tell them apart.
This article will explain the differences between an anal fissure and a fistula and how each condition is diagnosed and treated.
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An anal fissure and a fistula can have similar symptoms. Rectal bleeding and pain during bowel movements are symptoms of both conditions. But other signs and symptoms of these conditions can help differentiate between them.
The symptoms of an anal fissure can include:
The symptoms of a perianal fistula can include:
A fistula and a fissure form in different ways and may be associated with other conditions.
Anal Fissure
An anal fissure begins as a tear in the lining of the anus. It’s believed that many acute fissures (those that come on suddenly) may be due to tension in the muscles of the anus.
However, there are several other possible reasons for a fissure, especially for those that are long-lasting (chronic), including:
Fistula
A fistula is a connection between two internal organs or an organ and the skin that shouldn’t be there. The development of a fistula in the anal area commonly begins with an infection. It starts as anabscess, which is a pocket of pus. In some cases, this may create a lump or a bump under the skin in the anal area.
This abscess may eventually break open, creating a passage between two organs, a fistula. A fistula can form between:
Some of the underlying causes of a fistula include:
There is some overlap in how an anal fissure and a fistula are diagnosed.
A history of changes in bowel movements is also important to bring up, including diarrhea and constipation. The duration of symptoms, such as how many times a day or week, is important. Keeping a diary of symptoms can be helpful when working with a healthcare provider.
In some cases, the fissure will be seen during a physical exam of the anal area. Other tests can include:
In some cases, adigital rectal examis done. A gloved, lubricated finger is quickly inserted into the rectum to check for any lumps.
Tests that might be used to diagnose a fistula in complex situations include:
Anal fissures and fistulas will be treated differently, so it’s important to get an accurate diagnosis.
An anal fissure may heal on its own with someat-home treatments, such as over-the-counter (OTC) medications and lifestyle changes. More complex or persistent fissures may need treatment with prescription medications or surgery. Treatments include:
An abscess might be treated with antibiotics or drainage, and a fistula might be treated with a seton or medications.
Setons: A seton is a loop of material that’s threaded through the tract of the fistula. It’s made of flexible materials such as silicone, nylon, silk, or a surgical suture. A seton keeps the fistula tunnel open so that any pus or other fluid can drain and the fistula can heal.
Medications: Prescription medications might be used to help the abscess and/or the fistula heal. Antibiotics can help clear up an infection. If the fistula is associated with another condition, such as Crohn’s disease, treating the underlying illness with medications may be part of the healing process.
Surgery:Different types of surgerymight be used to heal a fistula. This can include closing one side of the fistula tract or opening it completely and cleaning it out so that it may heal cleanly.
Ostomy surgery may be needed in complex cases. In this procedure, part of the intestine is brought through the wall of the abdomen, creating astoma. Stool leaves the body through the stoma and is caught in an appliance worn on the abdomen. The appliance is emptied into a toilet when needed. Sometimes the ostomy is removed when the fistula heals.
For situations in which a fistula keeps occurring, surgery may be done to remove the rectum and the anus. In this case, the ostomy will become permanent.
It won’t always be possible to prevent a fissure or a fistula. However, there are a few things to keep in mind if you are at risk of developing one of these problems or have had them in the past.
Fissure
Fissures might occur with constipation or diarrhea, so it’s worth paying attention to bowel habits and ensuring that stool is soft and easy to pass. Exercise, dietary fiber, hydration, and avoiding straining on the toilet may help prevent an anal fissure.
Anal Fistula
A fistula may not be preventable in some cases. If you have Crohn’s disease, ensuring the condition is well-managed may help prevent complications such as a fistula. If you are receiving bowel cancer treatment, including radiation or surgery, ask a healthcare provider about fistula prevention.
General advice to maintain good bowel habits includes not sitting on the toilet too long or straining, drinking enough water, eating fiber, and getting regular exercise. See a healthcare provider regularly and especially when something seems different about bowel movements.
Summary
Anal fissures and fistulas both affect the area in and around the anus, but they are treated differently. For that reason, it’s important to see a healthcare provider about pain or bleeding from the rectum to get a diagnosis and treatment.
A Word From Verywell
Having symptoms with a bowel movement can be upsetting and frustrating. Many people are concerned that any bleeding or pain is cancer, but anal fissures are more common, and anal fistulas can be associated with certain other conditions, such as Crohn’s disease.
Caring for your digestive health includes everything from diet and hydration to exercise to seeing healthcare providers regularly. It can be embarrassing to talk about bowel movements, but it is nothing your providers haven’t heard before, and they are trained to help you with any issues.
With treatment, the symptoms should start to improve after a few days. The pain might start to subside quickly, but the fissure could take some weeks to fully heal. After four to five weeks, there should be some progress in healing. If not, it may be time to consider more intensive treatment.Learn MoreAnal Fissure Treatment
With treatment, the symptoms should start to improve after a few days. The pain might start to subside quickly, but the fissure could take some weeks to fully heal. After four to five weeks, there should be some progress in healing. If not, it may be time to consider more intensive treatment.
Learn MoreAnal Fissure Treatment
Most people may first see a general healthcare provider (who may be a general practitioner, family care nurse, or family care physician) about a fissure or a fistula. For an uncomplicated fissure, most treatment is done at home with conservative care, which a general healthcare provider can oversee.For a complicated fissure or a fistula, a consultation with a gastroenterologist and/or a colorectal surgeon will be needed to get more specialized care.Learn MoreColorectal Surgeons and Gastroenterologists
Most people may first see a general healthcare provider (who may be a general practitioner, family care nurse, or family care physician) about a fissure or a fistula. For an uncomplicated fissure, most treatment is done at home with conservative care, which a general healthcare provider can oversee.For a complicated fissure or a fistula, a consultation with a gastroenterologist and/or a colorectal surgeon will be needed to get more specialized care.
Most people may first see a general healthcare provider (who may be a general practitioner, family care nurse, or family care physician) about a fissure or a fistula. For an uncomplicated fissure, most treatment is done at home with conservative care, which a general healthcare provider can oversee.
For a complicated fissure or a fistula, a consultation with a gastroenterologist and/or a colorectal surgeon will be needed to get more specialized care.
Learn MoreColorectal Surgeons and Gastroenterologists
Blood in or on the stoolis always a reason to see a healthcare provider, in order to get a diagnosis and treatment. You should seek care right away for a lump or a bump around the anus.
Learn MoreWhen to See a Healthcare Provider for Rectal Pain
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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