Hemorrhoids and anal fissures are the most common anorectal diseases. Many patients often confuse bleeding from anal fissures with bleeding from hemorrhoids. In fact, as long as one has a certain knowledge of medical常识, it is quite simple to differentiate between the two.
Experts from Zhengzhou Huashan Anus and Intestine Hospital introduce that hemorrhoids and anal fissures are the most common anorectal diseases. Many patients often confuse bleeding from anal fissures with bleeding from hemorrhoids. In fact, as long as one has a certain knowledge of medical常识, it is quite simple to differentiate between the two.
In the early stage of hemorrhoid patients, bleeding is the main symptom, and the blood in stool is bright red; in the later stage, the hemorrhoid nucleus may protrude outside the anus during or after defecation, with secretions around the anus, causing dampness and itching. There may be constipation or a feeling of fullness, but generally no pain. However, if there is thrombosis, edema, inflammation, incarceration, or necrosis, there may be accompanying pain.
On the other hand, more than 80% of anal fissure patients experience pain, which can occur during, after, or when passing stool, presenting as continuous pain, sometimes like being cut by a knife, lasting for several hours, making the patient restless. The cause of the pain is mainly due to the direct stimulation of the expanded ulcerated wound by the stool during defecation. Pain can also stimulate the internal sphincter muscle, causing it to spasm, which increases the pain. This forms a vicious cycle until the internal sphincter becomes fatigued and relaxed, and the pain gradually subsides. Of course, anal fissures can also cause bloody stools, but generally not in large amounts, with bright red color, sometimes staining the toilet paper, or attached to the surface of the stool, sometimes dripping blood, caused by defecation leading to pain, patients often dare not defecate, which can eventually lead to habitual constipation.
In addition, local anal examination can be used for differentiation. Hemorrhoids mainly present as soft lumps on the mucosa above the dentate line, which may be congested, swollen, and have bleeding points; or lumps protruding below the dentate line. They are commonly found at the bladder lithotomy position at 3 o'clock, 7 o'clock, and 11 o'clock (i.e., left middle, lower right, upper right), commonly known as the "mother hemorrhoid area".
On the other hand, anal fissures are full-thickness splits in the anal canal skin that form chronic, spindle-shaped ulcers. The affected areas are mostly located at the lithotomy position at 6 o'clock and 12 o'clock. Early-stage anal fissures only have a small spindle-shaped ulcer on the anal canal skin, with shallow ulcers, fresh red fissures, neat edges, and elasticity, making them relatively easy to cure; chronic anal fissures are mostly due to untreated early-stage fissures, leading to long-term infection and chronic irritation, keeping the internal sphincter muscle in a state of sustained contraction and spasm, resulting in poor drainage of the fissure, long-term non-healing of the ulcer, increased fibrous tissue, and the possible formation of "six major attachments", including ulcerated wounds, anal fissure tags, sentinel hemorrhoids, anal sinusitis, hypertrophy of the anal papilla, subcutaneous fistulas, and the formation of a cylinder-like structure around the wound.