Hemorrhoid or Fissure?: May 11, 2014

While it may not be the subject of casual conversation, rectal bleeding is something you should discuss with your doctor. But very often people are embarrassed and brush it off.

 “A lot of people think ‘oh I have bleeding from my bottom, it’s just hemorrhoids’ and that’s not always the case,” says Dr. Jeffrey Neale, a colorectal surgeon on medical staff with Lee Memorial Health System.

When someone presents with bleeding, the first thing doctors want to do is rule out cancer.

 “We have to work them up with our gastrointestinal colleagues to make sure there’s no bleeding from the rest of the colon or in the rectum and make sure there’s no polyps or cancers present,” says Dr. Neale.

Most times, the bleeding results from either a hemorrhoid or fissure. Both are visible on a rectal exam. While they may have the same end point- they are very different conditions and have symptoms that set them apart.

 “If you’re having pain it could be an anal fissure. An anal fissure is a tear in and around the anus that can cause quite a significant amount of pain,” Dr. Neale says.

Generally caused by trauma, strain or bowel disease, fissures are associated with pain and blood during a bowel movement. A hemorrhoid is an engorged or inflamed vein in the rectal region. Clotted or external hemorrhoids may involve a lump. And constant discomfort, not limited to using the bathroom.

 “There’s inside hemorrhoids and outside hemorrhoids. They’re all treated similarly even though they’re somewhat different,” says Dr. Neale. “Outside hemorrhoids may present with pain and a large purple bump and if that’s slowly going away they usually would resolve on it’s own.”

Over the counter-medications and lifestyle and diet changes can usually rectify the problem. Your doctor may suggest further treatment if symptoms persist.