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Hemorrhoids vs fissure: differences

Published 22 February 2026 ·Last reviewed 22 February 2026 by the editorial team ·How we create our content

At a glance

Hemorrhoids and anal fissures are two of the most common causes of anal pain and bleeding. They can feel similar, which is why many people have difficulty telling them apart. This page outlines patterns people commonly describe — but only a doctor can properly diagnose your condition.

This page is for education, not diagnosis. If you are unsure what is causing your symptoms, see a doctor.

How people commonly describe the difference

Pain patterns

Fissure pain tends to be:

  • Sharp, cutting, or tearing during a bowel movement
  • Often intense and focused on one spot
  • May continue for minutes or hours after the bowel movement
  • Often described as “the worst part of the day”

Hemorrhoid discomfort tends to be:

  • More of an ache, pressure, or itching
  • Sometimes a burning sensation
  • Often less intense than fissure pain
  • May come and go regardless of bowel movements

Bleeding patterns

Fissure bleeding is typically:

  • Small amounts of bright red blood on toilet paper
  • Usually associated with pain during the bowel movement

Hemorrhoid bleeding is often:

  • Bright red blood that may drip into the toilet
  • Sometimes heavier than fissure bleeding
  • May occur without significant pain

Physical signs

Fissures may present as:

  • A visible small cut or tear
  • Usually located at the back or front midline of the anus

Hemorrhoids may present as:

  • Swelling or lumps around the anus
  • A feeling of fullness or pressure
  • Tissue that may protrude during bowel movements

Common triggers

Both conditions can be triggered by:

  • Constipation and straining
  • Hard stools
  • Pregnancy and childbirth
  • Prolonged sitting

Fissures specifically may also be triggered by:

  • Diarrhea
  • A single episode of straining

Hemorrhoids specifically may also be related to:

  • Heavy lifting
  • Chronic straining over time
  • Aging

Why self-diagnosis is unreliable

Many people report that their symptoms do not fit neatly into one category. Some common reasons:

  • You can have both conditions at the same time
  • Internal hemorrhoids are not visible externally
  • Some conditions have overlapping symptoms
  • Other conditions can cause similar symptoms

If you are uncertain, seeing a doctor is the most reliable path to clarity.

Common questions

What is the difference between hemorrhoids and a fissure?

Hemorrhoids are swollen blood vessels in or around the anus, while a fissure is a small tear in the anal lining. They can cause similar symptoms like bleeding and discomfort, but the pain patterns and physical signs tend to differ.

Can you have both hemorrhoids and a fissure?

Yes. It is possible to have both conditions at the same time. A doctor can help determine what is contributing to your symptoms.

Should I try to diagnose myself?

Self-diagnosis is not recommended. If you have symptoms that concern you, see a doctor for a proper assessment. This page is for education, not diagnosis.

When to seek care Heavy bleeding or feeling faint? Get emergency help now. Emergency: 911

Not sure how urgent it is? Get help today.

  1. Emergency

    Heavy bleeding, black tarry stools, feeling faint, severe pain or trouble breathing.

    Call 911 or go to the ER.

  2. Today

    Fever, pain getting worse, a hot swollen lump, or trouble passing urine.

    Call your doctor or go to urgent care.

  3. Soon

    Bleeding or bowel changes nobody has checked, or anything lasting 3 weeks.

    Book a doctor’s appointment.

Feeling overwhelmed? Call or text 988, any time.

See all the signs

For this topic, get medical advice if you notice:

  • Heavier or persistent bleeding that does not settle
  • Severe pain that is not relieved by over-the-counter measures
  • A hard, painful lump near the anus that appeared suddenly
  • Symptoms that have not improved after two weeks of self-care
  • Fever alongside anal or rectal symptoms
  • Any rectal bleeding if you are over 40 or have a family history of colorectal conditions

Recording how you feel is not the same as being checked. These are the signs that need a doctor’s attention.

Call 911 or go to the emergency room now if you have:

  • bleeding that will not stop, a lot of blood (the toilet water turns red, or you pass large clots), or any bleeding with feeling faint or dizzy
  • fainting, a racing heart or trouble breathing
  • confusion or slurred speech, extreme shivering, no urine in a day, or blotchy skin
  • sudden severe belly pain, or a swollen, hard belly with vomiting or not passing stool or gas
  • you cannot pass urine at all, or your bladder feels full and painful and you can’t empty it
  • redness, swelling or severe pain spreading quickly around your anus, genitals or groin, especially with a fever or feeling very ill
  • a fever with a painful swelling near your anus if you have diabetes or a weakened immune system (for example, from chemotherapy or transplant medicines)
  • black, tarry stools

Call your doctor or go to urgent care today (or the ER if you can’t be seen today) if you have:

  • a temperature of 100.4°F (38°C) or higher, chills, vomiting, or feeling generally unwell
  • pain that is getting worse over days, or severe pain that stops you sitting or sleeping
  • a hot, swollen or very tender lump near your anus or at the top of the crease between your buttocks, or foul-smelling discharge
  • trouble urinating
  • bleeding that is getting heavier or more frequent, or blood mixed into your stool
  • feeling much more tired than usual, looking pale, or getting out of breath more easily than you used to
  • not passing stool for several days, or new belly pain

Make an appointment with your doctor if:

  • you have never had these symptoms checked by a doctor or nurse — whatever your age
  • you have had rectal bleeding for more than 3 weeks
  • your bowel movements have been looser, thinner or more frequent than usual for 3 weeks or more, or you have lost weight without trying
  • symptoms have not settled after a week or so, or keep coming back
  • you notice a new lump near your anus, between your buttocks or in your belly, or an itch or discharge that does not clear
  • you have new leakage or trouble controlling your bowels
  • you are 45 or over, or have a family history of bowel cancer or inflammatory bowel disease, and any of these symptoms are new for you

If you are unsure, it is always reasonable to ask. If things feel overwhelming, call or text 988 (Suicide & Crisis Lifeline) or chat at 988lifeline.org, any time. If you don’t feel safe, call 911.

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Related symptoms

BleedingPain during bowel movementsPain after bowel movementsItchingSwelling or lumpPressure or fullnessProtrusion

Discreet symptom tracking

Symptoms that come and go? Keep track, day by day.

For hemorrhoids, fissures, fistulas and other anal and rectal problems. A short, discreet email asks how things have been, and saves each answer, so you can look back at every flare and every good week in your own words. If you haven’t had your symptoms checked, see your doctor first.

  • About ten seconds a check-in. No app, no password.
  • Nothing in the subject or preview says what it’s about.
  • Each Sunday, a link to your week, ready for your next appointment.
Start tracking →

Your notes

Your check-in

Takes about ten seconds.

20:00
Example. Nothing on the lock screen hints at symptoms or conditions.

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