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From Pain to Treatment: Distinguishing Piles from Fistula

Updated: Mar 19

From Pain to Treatment: Distinguishing Piles from Fistula

Anal pain has a high potential to cause severe misery. The most common causes of this discomfort are hemorrhoids and fistulas. Even if there may be some overlap in symptoms, the two illnesses are different problems that need different advanced treatment strategies.

Understanding Piles

Piloses, or hemorrhoids, are swollen veins in the rectum or anal canal. The increased pressure in the pelvic area causes these veins to expand.

There are several potential causes for this pressure, including:

  • Straining when passing stool because of constipation or ongoing diarrhea

  • During a pregnancy

  • Being chubby

  • Inadequate dietary fiber

  • Using the loo a lot of the time


Symptoms of piles include:

  • Pain and discomfort during bowel movements

  • Bright red Anal bleeding may or may not be visible after passing stool.

  • Discharge of mucus from the nose

  • Feeling of a lump near the anus

  • Irritation around the anus


The severity of these symptoms may vary depending on the type and grade of piles.

There are two kinds Different grades of Piles:


Internal piles: Develop within the rectum and may occasionally emerge from the anus during defecation.

External piles: Form beneath the skin in the vicinity of the anus. These may cause more discomfort and are more inflammatory bowel disease.

Understanding the Fistula?

From Pain to Treatment: Distinguishing Piles from Fistula

An uneven connection between the anus and the surrounding skin, or perhaps even to another organ, is called a fistula. It's a drainage path that appears when an infected pus collection called an anal abscess bursts.


You can look at fistulas in more detail here:

The most common cause is an inflamed anal gland that bursts and generates a drainage tube. Additional causes include trauma, Crohn's disease, and sexually transmitted infections (STIs).


  • Pain is generally throbbing or persistent, especially when sitting or voiding.

  • Redness and swelling around the anus.

  • Pus appears via the fistula's aperture.

  • Fever (in some instances).

  • The lack of ability to regulate one's bowel motions

  • The tunnel-like connection and frequent discharge of pus distinguish a fistula from a pile.

You must see a doctor if you think you might have a fistula as a result of these symptoms. 


Early detection and intervention can help avoid complications. The physician will perform a physical examination and maybe other tests to determine the kind and presence of a fistula before recommending the best course of action.

Difference between Piles and Fistula

From Pain to Treatment: Distinguishing Piles from Fistula

While both fistulas and piles (hemorrhoids) may make it uncomfortable for you to use the restroom, they have different origins and call for other forms of treatment. Understanding these essential distinctions may enable you to obtain the appropriate medical treatment.


The Source of the Issue:


  • Piles: Visualize protruding varicose veins in the rectum or anal canal. This is the nature of heaps. Increased pressure in the pelvic area from straining during bowel movements (constipation or diarrhea), pregnancy, obesity, a diet low in fiber, or even prolonged periods of sitting on the toilet seat can all contribute to this vein growth.


  • Fistula: A fistula is an uneven, infected tunnel rather than an enlarged vein like piles are. This drainage tube is created when an infected anal gland, a small pocket that secretes mucus close to the anus, bursts. Sexually transmitted infections (STIs), Crohn's disease, and, less frequently, trauma are additional risk factors for the creation of fistulas.

Symptoms of Piles and Fistulas

From Pain to Treatment: Distinguishing Piles from Fistula

Fistulas and piles, also referred to as hemorrhoids, are two conditions that affect the anal area. Even if they have specific common symptoms, they are different problems. Here is a summary of their symptoms to better understand each of them.


Visible symptoms of Piles

Pile is the term for the blood vessels that jut out around the rectum and anus. They might be internal, situated within the rectum, or they could protrude outside the anus, or there may be swollen blood vessels. Numerous symptoms may arise from piles, contingent on their type and extent.


Typical examples are as follows:

Bleeding: Bright red Anal bleeding is a hallmark indication of piles. Blood in the stool may show up as streaks in the stool or on toilet paper after a bowel movement.

Soreness and Pain: Anus soreness is a common complaint, especially when seated. There could also be a burning or stinging feeling.

Itching: The anal area may become inflamed and uncomfortable due to prolonged wetness or friction.

Lump or swelling: Although inner piles may not manifest any obvious signs, exterior piles may result in a lump at the anus. This lump may be touch-sensitive and may protrude during bowel movements.

Mucus discharge: If there is discomfort from external piles, there may be a mucus flow from the anus.

Feces may leak: If piles are large, there may be a significant amount of stool leakage.


Symptoms of Fistulas

An artificial tunnel connecting the anus to the anal skin surrounding the anus is called an anal fistula. A pus-filled deposit known as an infected anal abscess may cause this tunnel to form. These are a few of the main signs of a fistula:

  • Acute fissures: throbbing pain is a common side effect of fistulas, particularly while sitting, coughing, or passing stool.

  • Swelling and redness: Swelling and redness surrounding the fistula opening are signs of inflammation.

  • Drainage: The fistula hole next to the anus may discharge pus, blood, or feces. This drainage system may smell bad.

  • Skin irritation: The frequent draining may irritate the anal skin surrounding it, causing pain and itching.

  • Fever: A fistula may occasionally experience a fever, indicative of an infection.


What to Avoid in Piles and Fistulas

From Pain to Treatment: Distinguishing Piles from Fistula

In the anal region, fistulas and piles (hemorrhoids) can be highly uncomfortable. Even if therapy necessitates medicinal intervention, a few lifestyle adjustments can significantly improve your condition and prevent flare-ups. The following guidance will assist you in preventing the worsening of piles and fistulas:

  1. Low-Fiber Foods: A low-fiber diet strains the anal area and exacerbates piles and fistulas by causing stools to become stiff and difficult to pass. Steer clear of processed carbohydrates such as pasta, white bread, and sugary snacks. Choose fruits, vegetables, whole grains, and legumes to increase your fiber intake and soften your stools.

  2. Spicy Foods: Consuming spicy food might aggravate the digestive system, causing discomfort and increased anal bleeding. Eat fewer curries, chili peppers, and other spicy foods.

  3. Caffeinated Beverages: Drinking too much coffee and other caffeinated beverages can cause dehydration and hard stools. Caffeine can also quicken bowel movements, which can cause additional strain in the anal area. Think about consuming less coffee or substituting herbal teas.

  4. Alcohol: Drinking alcohol can cause dehydration and irritation of the anal lining, which can exacerbate fistulas and piles. If you can, limit your alcohol intake or stay away from it entirely.

  5. Straining During Bowel Movements: Straining to pass feces is a significant factor in fistulas and piles. Ensure you eat enough fiber and drink enough warm water to avoid constipation and strain. If you need to use stool softeners, talk to your doctor.

  6. Extended Sitting: Extended sitting strains the anal region, especially the hemorrhoids. Get up and move about every thirty minutes to increase circulation and lower stress levels.

  7. Heavy Lifting: Lifting heavy weights may compress the varicose veins in the anal region, exacerbating piles. Consult a physician if you have concerns about safe lifting procedures. Avoid lifting massive objects and observe safe lifting techniques.

  8. Wiping Brutally: Excessive or rough toilet paper use might irritate the anal region. Use moist wipes or soft, fragrance-free toilet paper for a kinder clean.

  9. Tight Clothes: Clothing that fits too tightly might hold on to moisture and make the anal region worse. Put on breathable, loose-fitting cotton pants to enhance ventilation and lessen pain.


Impact of Anal Disorders on the Body

From Pain to Treatment: Distinguishing Piles from Fistula

Anal illnesses, which include conditions like hemorrhoids and fistulas, are typically seen as unattractive, bothersome conditions. But its effects can go far beyond localized pain, jeopardizing overall health and wellbeing.

Here's a closer look at the potential health effects of anal issues:

1. Pain and Strain in the Body:

The physical strain and discomfort that anal issues cause are their most prominent effects. Itching, bleeding, and pain during bowel movements can significantly interfere with daily activities. Prolonged standing, walking, or even sitting down could cause pain. This discomfort has the potential to disrupt sleep patterns, which can result in fatigue and a lower standard of living.

2. Problems with the Digestive System:

Anal issues might hamper digestion. Chronic constipation can result from difficult and unpleasant bowel movements caused by hemorrhoids and fistulas. Restricting oneself to expel waste can exacerbate hemorrhoids and lead to involuntary stool leaking or fecal incontinence. Under extreme medical conditions, these problems could result in starvation and dehydration.

3. Emotional and Mental Cost:

Mental and emotional health can suffer significantly from the ongoing discomfort and embarrassment related to anal issues. Typical results include social isolation, depression, and anxiety. People may avoid social situations out of fear of embarrassing themselves in front of others, which would lower their quality of life.

4. Problems and Infections:

If left untreated, anal issues might cause serious difficulties. Hemorrhoids can strangle, causing excruciating pain and tissue death. Infected fistulas may develop pus-filled collections known as anal abscesses, which must be surgically removed. In extreme cases, there is a risk to life as these diseases can spread easily.

5. Effect on Day-to-Day Activities:

Anal problems can cause pain and discomfort that can significantly interfere with day-to-day activities. Weak concentration and frequent bathroom breaks might negatively impact work performance. Overall fitness and health may diminish due to difficulty with exercise or avoiding physical activity.

The Best Treatment for Piles and Fistulas

From Pain to Treatment: Distinguishing Piles from Fistula

Although they are two different disorders, piles (hemorrhoids) and fistulas can both produce a great deal of discomfort in the anal area. Thankfully, several therapy choices are available to address these problems, reduce symptoms, and enhance the quality of life.

The Best Treatment for Piles and Fistulas

The severity of the condition determines the appropriate course of action for piles and fistulas. 

Below is a summary of the many methods:

Hemorrhoids in Piles

For Grade I and II hemorrhoids, which are usually mild, home treatment options such as over-the-counter pain medications, warm baths, and a diet rich in fiber can be effective.

In cases of Grade III and IV hemorrhoids, which are more severe and painful, less invasive procedures like laser therapy, injectable sclerotherapy, or rubber band ligation may be recommended.

In certain circumstances, surgery such as a hemorrhoidectomy may be necessary to remove the hemorrhoid. However, this is typically reserved for cases where other treatments have failed to provide relief.



There is no medicine for fistulas, in contrast to piles. Surgery is typically required to seal the aberrant tract during advanced treatments. The location and complexity of the fistula will determine the type of surgery needed. The following are a few surgical techniques:

  • Fistulotomy: This treatment entails opening the fistula tract to facilitate healing and drainage.

  • Seton placement: To maintain patency and encourage drainage, a seton is a tiny piece of suture inserted into the fistula tract.

  • Advancement flap surgery: This procedure closes the fistula opening by using healthy rectum tissue.


Here are some more recommendations for treating hemorrhoids and anal fissures:

  • Ensure the perianal area is dry and clean to guarantee optimal hygiene.

  • Steer clear of applying too much pressure when removing waste.

  • Drink enough warm water to help the stool soften.

  • Include high-fiber diet to encourage regular bowel movements.

  • When someone exhibits signs of anal fissures or Chronic fissures, they should consult a medical specialist for a precise diagnosis and suitable treatment. Prompt action can reduce the likelihood of problems.


Facts About Piles

From Pain to Treatment: Distinguishing Piles from Fistula

1. No one gets hemorrhoids, but everyone has Piles:

You know those little pillows in your rectum and anus? Those are hemorrhoids—or, to be more precise, healthy hemorrhoids. They help regulate stools by acting like seals. These vascular structures don't become the painful heaps we fear until they swell and become irritated.


2. Pregnancy Powerhouse:

Although it's a beautiful time, being pregnant can be hard on your body, especially your veins. The strain of the developing baby on the pelvic area can cause hemorrhoids in up to 80% of pregnant women.


3. Factors Other Than Age Affect:

Haemorrhoids grow more common as we age because our tissues weaken. But suffering is not limited to older people. Pile piles can develop at any age due to straining during bowel movements, severe pain lifting, or prolonged sitting.


4. Fibre Is Your Friend:

Hemorrhoids can be very painful if you are constipated. You may maintain optimal blood flow and prevent further strain on your vulnerable veins by including an abundant, healthy diet by adding fruits, vegetables, and nutritious grains to your diet. You should always consume diet-rich foods for a better blood supply.


5. Not Always a Pain:

Although hemorrhoids can be quite painful, they don't always hurt. While external hemorrhoids may be more noticeable but not always painful, internal hemorrhoids may cause some mild bleeding. To rule out other possible causes, you should see a doctor if you suffer from any symptoms.


Facts about Fistulas

From Pain to Treatment: Distinguishing Piles from Fistula

1. Royalty's Ailments: Unbelievably, there is some historical association between fistulas and monarchy. Famously, France's King Louis XIV had a fistula-in-ano and had several unsuccessful surgeries to treat it. These treatments made him sicker in the end and possibly led to his demise.


2. Little Mischief-Makers, Serious Issues: Even though fistulas are tiny, they can be very distressing. The symptoms might vary depending on the area, ranging from discomfort and recurrent infections to foul-smelling discharge and trouble controlling human body functions.


3. Bowel Bonus Round: Is it true that certain benefits are associated with fistulas? Some forms, such as a biliary enteric fistula, can be intended as surgical outcomes to aid in the removal of bile from the liver following surgery.


4. From Famine to Fistula: In underdeveloped nations, fistulas are an incredibly prevalent medical condition. Malnutrition and poor sanitation may increase the risk of infections that might ultimately lead to the development of a fistula.


5. Fistula Fighters: Treatment options for fistulas are generally favorable. Treatment methods might vary depending on the type and location, ranging from medication and healthy lifestyle modifications to surgery and specialized procedures such as fistula plugs.



  • Can piles turn into fistulas? The anus is the external orifice via which waste is expelled from the body. Inside the anus are several small glands that secrete mucus. Periodically, these glands clog and may become infected, leading to an abscess. Of these abscesses, fistulas could develop in about 50%.

  • How do I know if I have piles or fistulas? Piles may be seen inside or outside. An internal fistula is always present. Symptoms: Swelling and soreness in the anal region, usually at the anal orifice, are typical signs of piles. Fever, discomfort, and pus or blood leaking from the anal orifice are signs of an anal fistula.

  • Is a fistula more painful than a pile? While piles and fistula pain can both be bothersome, fistula pain has the potential to be more severe. This is an explanation: Piles: Pain, particularly during bowel movements, can vary from a slight discomfort to a strong burning feeling. While exterior piles can be tender, especially when thrombosed (a blood clot forms), inside piles may not hurt at first. Fistula: usually characterized by throbbing discomfort around the anus, especially during sitting or standing. It might be really annoying to have the diseased tract irritate you all the time. In addition, if the infection gets worse, fistulas might result in fever and chills. Factors affecting severity: position: Compared to some exterior pile placements, the deeper position of a fistula may cause more severe pain. Infection: Compared to non-infected piles, the presence of infection in a fistula considerably increases pain.

  • How do you confirm piles? A doctor can usually diagnose piles through a physical exam and possibly a digital rectal exam. In some cases, additional tests like an anoscopy or colonoscopy might be needed.

  • Can a fistula be cured permanently? Fistula surgery has a high success rate, but recurrence is a possibility. Maintaining good hygiene and managing any underlying conditions can help reduce the risk of a fistula coming back.

  • Do piles affect marriage life? Piles themselves shouldn't directly impact your marriage life. However, the discomfort and pain they can cause might affect intimacy. If you're experiencing hemorrhoids, talk to your doctor about treatment options to manage symptoms and improve your quality of life.


In summary, while both hemorrhoids and anal fistulas can be painful, they differ significantly in their causes and treatment approaches. Recognizing these distinctions empowers individuals to seek appropriate medical attention promptly. Hemorrhoids, stemming from venous engorgement, often necessitate surgical interventions or lifestyle adjustments for resolution. In contrast, anal fistulas, arising from abnormal tracts due to infectious causes, typically require procedural interventions or lifestyle modifications. Swift medical consultation is recommended upon experiencing suggestive symptoms, as timely diagnosis plays a crucial role in averting potential complications.

Written by: Khushi Bhatia

Edited by: Aniket Joshi

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