Piles (Haemorrhoids) and Anal Fissure
About the disease & condition
Piles (Haemorrhoids):** Vascular cushions in the anal canal that become symptomatic due to swelling, inflammation, or prolapse. Classified as internal (above dentate line) or external (below dentate line).
Anal Fissure:** A small tear or ulcer in the lining of the anal canal, typically in the posterior midline.
Aetiology & Pathophysiology
Piles:**
- Increased pressure in the hemorrhoidal plexus due to straining during defecation, chronic constipation, pregnancy, obesity, or prolonged sitting.
- Weakening of supporting tissues with age.
Anal Fissure:**
- Trauma from the passage of hard stools, diarrhoea, or childbirth.
- Hypertonicity of the internal anal sphincter leads to reduced blood flow and impaired healing.
Symptoms & Signs
Piles:**
- Internal: Bright red rectal bleeding (on wiping or in toilet), prolapse, discomfort.
- External: Pain (if thrombosed), swelling, itching.
Anal Fissure:**
- Sharp, tearing pain during and after bowel movements, often with bright red bleeding on toilet paper.
- Visible tear on inspection; sentinel skin tag may be present.
Red flags:** Persistent bleeding, weight loss, change in bowel habits (to rule out malignancy).
Diagnosis
- Clinical history and visual inspection.**
- Digital rectal examination (avoided in acute fissure due to pain).**
- Anoscopy:** To visualise internal haemorrhoids or fissure.
- Sigmoidoscopy/colonoscopy:** If concerned about colorectal pathology (e.g., unexplained bleeding).
Management & Treatment
Conservative measures (first-line for both):**
- High-fibre diet, adequate hydration.
- Sitz baths (warm water baths) for soothing relief.
- Topical analgesics, steroids (short-term for piles), or barrier creams.
Piles-specific:**
- Rubber band ligation, sclerotherapy, and infrared coagulation for internal haemorrhoids.
- Haemorrhoidectomy for severe or thrombosed cases.
Fissure-specific:**
- Topical nitroglycerin or nifedipine (to reduce sphincter spasm and promote blood flow).
- Botulinum toxin injection or lateral internal sphincterotomy for chronic fissures.
Potential Complications
- Piles:** Thrombosis (painful external haemorrhoid), anaemia (from chronic bleeding), strangulation.
- Anal Fissure:** Chronic fissure, incontinence (rare, from surgical complications), fistula formation.
Prevention & Follow-up
Prevention:**
- Avoid straining during defecation; maintain regular bowel habits.
- High-fiber diet, exercise, weight management.
Follow-up:**
- Most cases resolve with conservative management; reassess if symptoms persist.
- Surgical follow-up as needed for procedural aftercare.
Relevant Specialities
Gastroenterology
Gastroenterology is the specialty focused on the digestive system and its functions.
It supports patients with a wide range of digestive health concerns, helping maintain overall gastrointestinal health and well-being through early identification and long-term management.
At KIMSHEALTH, care is delivered through a patient-centered approach, focusing on accurate diagnosis, prevention, and ongoing support.
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Our medical teams bring together advanced expertise with a deeply human approach to care. From everyday care to highly specialised treatment, we ensure you feel informed, reassured, and supported throughout your journey - so your experience with us is seamless and secure.
