Pain while passing stool is one of the most common reasons patients visit my clinic. Often, they come thinking it’s piles. But it’s not always piles. Many times, it’s either a fissure or a fistula. These two conditions sound similar, but they’re not the same. I see confusion between them all the time. So let’s clear it up.
Knowing the difference between fissure and fistula helps patients get proper treatment. It also reduces unnecessary fear and delays.
What Is a Fissure?
A fissure is basically a tiny tear in the skin right inside the anus. Most times, it happens after passing hard stools or trying to push too much. Constipation is usually the reason. Sometimes it’s the opposite—frequent loose motions that irritate the area. That small tear ends up exposing nerves underneath, and that’s why it stings so much. The pain can be really sharp. And in many cases, there’s a bit of bright red blood either on the toilet paper or in the toilet after passing stool. In such cases, timely anal fissure treatment can help relieve pain, promote healing, and prevent recurrence.
The pain is intense. It burns, especially during and after passing stool. In some patients, it lasts for hours. Over time, if it doesn’t heal, the muscle around the anus (the sphincter) stays tight. This reduces blood flow and prevents healing. That’s when it becomes chronic.
What Is a Fistula?
A fistula is an abnormal tunnel between the inner lining of the anus and the skin around it. It usually forms after an untreated abscess. Pus collects, bursts, and drains. But the infection doesn't fully go away. Instead, a track forms. That’s the fistula. It leaks pus or stool from a small opening near the anus. In such cases, fistula surgery is often required to treat the condition effectively and prevent recurrence.
Unlike fissures, fistulas don’t cause pain while passing stool. But the skin gets irritated. There’s swelling, pus, foul smell, sometimes even bleeding. The opening may close temporarily, then burst open again. It keeps coming back until treated properly.
Key Differences You Should Know
Let me break down anal fissure vs fistula in the simplest way.
Symptoms That Overlap
Some patients have both conditions at the same time. That’s why diagnosis is important. Pain, swelling, and discharge can overlap. But their pattern is different. Fissure pain is sharp and occurs during bowel movement. Fistula pain comes with swelling or pressure. There might be a boil-like feeling.
What Causes Fissure and Fistula?
Fissures are mostly due to trauma from hard stools or diarrhea. But low blood flow, inflammatory diseases, childbirth, and even stress can play a role.
Fistulas are caused by infections that don’t heal. Common reasons include:
- Untreated anal abscess
- Crohn’s disease
- Tuberculosis
- Surgery or trauma
- Radiation therapy
In India, fistulas are fairly common due to delayed treatment of abscesses or the use of home remedies that don’t work.
How Are They Diagnosed?
I usually begin with a simple physical exam. Most fissures can be seen without instruments. If the pain is too much, I avoid using scopes on the first visit.
For fistulas, I check for external openings. I gently press the area to check for pus. Sometimes, I use a proctoscope. If it’s complicated, I may order an MRI or ultrasound to map the tract.
Blood tests are used to rule out infection or inflammatory conditions. If symptoms are severe or unclear, we may also recommend a colonoscopy.
Treatment Options of Fissue & Fistula
Fissure Treatment
Most fissures heal with:
- Stool softeners
- High-fiber diet
- Warm sitz baths
- Topical creams to relax the muscle
- Painkillers if needed
If there’s no improvement in 4-6 weeks, we consider surgery. The most effective one is Lateral Internal Sphincterotomy (LIS). It reduces muscle pressure and helps healing. It’s a short, safe procedure. Recovery is quick.
Other surgical options include fissurectomy or laser sphincterotomy. These work well for recurrent or non-healing fissures.
Fistula Treatment
Fistulas rarely heal on their own. We need to clear the infection and close the tract. Surgery is the only reliable option.
I offer these treatments based on the case:
- Fistulotomy: Opening the tract and allowing it to heal flat
- Seton Placement: A thread is placed in the tract to help it drain slowly
- Advancement Flap: A Tissue flap is used to cover the internal opening
- LIFT Procedure: The Tract is closed between the sphincter muscles
- Laser Closure or Fibrin Plug: Used for small or low-risk cases
Recovery Time of Fissue & Fistula
Fissure surgeries usually heal in 2–4 weeks. Pain goes away early. Full activity resumes quickly. For fistulas, healing may take longer—sometimes 6–8 weeks—especially if the tract is long or surgery is complex.
Choosing the Right Surgeon Matters
If you're confused about anal fissure and fistula, the best thing you can do is get it checked early. A quick exam can clear things up. You don’t have to guess or suffer silently.
If you’re in Gurgaon and you’ve been living with a fissure or fistula, don’t keep guessing what it is or waiting for it to go away. As a general surgeon in Gurgaon, I’ve seen enough of these cases to tell when it needs medicine, and when it needs a small surgery to actually fix the issue. At my clinic, I don’t rush people. I check properly, explain what’s going on in simple words, and we decide the next step together. If surgery is needed, I keep it clean and clear—no long hospital stays, no hidden problems later. Just straightforward care.
