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Hemorrhoids, Fissure, Fistula, and Rectal Cancer: An Overview

Posted On 17/01/20

Hemorrhoids, Anal Fissure, and Fistula are common conditions. These conditions share similar symptoms such as itchiness or pain and bleeding in the rectal area, and people often find it hard to understand the disease. Most often, these symptoms are indicative of hemorrhoids, but in most cases, the anal tissue has aggravated to result in fistula or fissure. Here we are discussing the similarities and differences between hemorrhoids, anal fistula, and fissures along with rectal cancer so that you can deal with the problem better.



Hemorrhoids or piles are a cluster of swollen and inflamed veins in the lowest part of the rectum. This is a common disease that affects about 75% of the population by age 50. This is one of the most unpleasant and embarrassing conditions when they are in the skin around the anus. Piles are not dangerous. However, they can bleed and become very painful. Hemorrhoids are of two types, internal and external.

Symptoms of hemorrhoids are similar to diseases like fissures, abscesses, warts, and polyps. So it is essential to conduct a physical exam and a digital rectal exam to diagnose hemorrhoids. Sometimes experts recommend a colonoscopy, sigmoidoscopy, and barium enema x-rays to make a thorough analysis to rule out other causes, like colon cancer in people over the age of 40.

Medical treatment
Medical treatment for internal hemorrhoids includes rubber band ligation, hemorrhoidectomy- cutting out hemorrhoid, or stapled hemorrhoidopexy.
Lifestyle changes can help to keep piles at bay to a certain extent. A high fiber diet, staying hydrated, and exercising softens the bowel movement and eliminates constipation. Applying topical pain creams can provide temporary relief from pain.

2. Anal fissures

An anal fissure is a small tear in the mucosa, the thin, moist line that lines the anus. This condition usually occurs when you pass large or hard stool during a bowel movement and causes pain and bleeding. Decreased blood flow and high tension in the sphincter muscles can also create an anal fissure. This condition is common in infants, adults, and people with Crohn's disease.  

Most common symptoms of an anal fissure include:

  • Sharp pain during a bowel movement
  • Bleeding
  • A visible crack in the skin of the anus
  • Constipation  

A rectal exam and visualization of the area can help diagnose anal fissures.

Most often, anal fissures heal on their own within 1-2 weeks. For infants, changing diapers and keeping the area clean can prevent and treat them. Adding fiber and fluids into the diet can smoothen the bowel movement, and using topical creams can soothe the area.

Treatments for chronic fissures include Surgical options or Botox injection into the sphincter. This can relax the anal sphincter and decrease pain and allow healing. Sphincterotomy, the procedure is to cut the hypertrophied internal sphincter, to release the tension, and allowing the fissure to heal is also recommended.

3. Anal Fistulas

An anal fistula is a small tunnel that connects the anal abscess. An anal abscess is a tiny gland in the anus that develops due to infection. A fistula can also develop without an abscess

Significant fistula causes are Crohn's disease, radiation, trauma, and cancer. Fatigue and fever or chills are common symptoms of anal fistulas. Other symptoms include pain, redness, and swelling, plus irritation of the skin around the anus and drainage of the abscess through the fistula.


  • surgical drainage of the abscess
  • Antibiotics

4. Rectal cancer

Rectal cancer is the growth of malignant or cancerous cells in the lower part of the rectum, which is a part of the digestive system. The exact cause of rectal cancer is unknown. Rectal cancer is more likely to occur in older people. Most often, people with this disease are diagnosed after age 50.

Most common symptoms of rectal cancer are:

  • Red blood is seen in the stool,
  • unexplained constipation
  • Diarrhea
  • changes in the diameter of the stool 

Rectal cancer screening methods include

  • Physical examination
  • Colonoscopy
  • Biopsy
  • Molecular testing
  • Blood tests
  • Computerized Tomography (CT)
  • Magnetic resonance
  • Ultrasound
  • Chest X-Ray
  • Positron Emission Tomography (PET)

Rectal Cancer


The treatment plan is prepared according to factors such as size, location, and stage of cancer, whether or not it is recurrent, and the current overall state of health of the patient. Treatment options include chemotherapy, radiotherapy, and surgery.

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Blog reviewed by: Dr.Nikhil Agnihotri
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