Many patients immediately say:
“Doctor, I have piles.”
But every problem around the anal region is not piles.
They occur in almost the same area and some symptoms such as pain, bleeding, itching and swelling may look similar. However, the actual problem inside the body and the treatment required for each condition can be different. Treating the condition only on the basis of symptoms, without proper examination, may lead to wrong treatment and the disease may continue to progress. Your own patient-education series emphasises that similar symptoms can occur in piles, fissure and fistula, while their treatment is different. So before starting any medicine, home remedy or procedure, it is important to understand: Is it piles, fissure or fistula?
Piles are also known as haemorrhoids, while Ayurveda describes the condition as Arsha. In piles, the veins and blood vessels around the anal region become enlarged. Along with this, fleshy tissue may increase and form a lump. In some patients, this lump may come outside the anal opening, especially while passing stool.
Common symptoms of piles may include:
An anal fissure is different from piles. A fissure is a cut, crack or tear in the anal opening. To understand it easily, imagine a crack developing on your lips. Whenever the lips stretch, the crack hurts. Similarly, when a tear develops at the anal opening, passing stool stretches the affected area again and can cause severe pain. The most important symptoms of fissure are:
Anal fistula is known as Bhagandara in Ayurveda. A fistula is not simply a swelling or wound. It involves the formation of an abnormal tract or tunnel around the anal region. As explained in our video series, infection may develop in glands around the anal canal. Pus begins to collect and may spread through the surrounding tissues. A painful boil or swelling can develop near the anus. When the boil bursts, pus comes out and the patient may temporarily feel better. However, an abnormal tract may remain inside. If its outer opening closes while the internal problem remains, pus may collect again. The swelling, pain and discharge can then return. Common symptoms of fistula may include:
Pain or bleeding alone cannot always tell you the exact disease.
A doctor needs to understand:
At Ashtang Ayurved Hospital, Otur, Junnar, the approach starts with understanding the patient’s symptoms, digestive health, bowel habits, lifestyle and previous treatment history. Depending on the patient’s condition, clinical examination and proctoscopy may be advised to identify the problem more clearly. Your hospital’s video script specifically mentions proctoscopy to understand which condition is present because piles, fissure and fistula require different treatment approaches.
The basic problem is different in all three conditions.
Do not delay medical examination if you have repeated bleeding, severe pain during stool, a lump coming outside, persistent itching, repeated swelling, pus discharge, fever with anal pain or a boil that repeatedly appears and bursts. You should also take persistent bleeding seriously rather than automatically assuming that it is piles. Your video guide points out that other anorectal and intestinal conditions can sometimes produce similar symptoms.
Piles, fissure and fistula affect the same general area, but they are not the same disease. Remember:
These are only clues, not a final diagnosis. At Ashtang Ayurved Hospital, Otur, Junnar, our focus is to understand the exact condition before planning treatment.
Piles involve swollen veins and increased fleshy tissue in the anal region. Fissure is a cut or tear in the anal opening. Fistula is an abnormal tract formed between the anal canal and nearby skin, commonly associated with repeated pus formation and discharge.
Piles commonly present with bleeding, swelling or a protruding lump. Fissure generally causes severe cutting or burning pain while passing stool. However, the final diagnosis should be made after examination.
Repeated swelling, boil formation and pus discharge around the anus can indicate fistula. Pain may increase when pus collects and reduce after it drains.
No. Bleeding from the anal region should not automatically be considered piles. Other anorectal and intestinal conditions may also cause bleeding.
According to the clinical pattern described in your video, fissure commonly produces severe pain while stool is passing because the stool stretches the existing tear.