What is the difference between anal fistula and hemorrhoids

Many people cannot effectively distinguish between anal fistula and hemorrhoids. In fact, their symptoms are different. Common symptoms of anal fistula are itching, pain, pus discharge, and difficulty in defecation, while hemorrhoids are mostly characterized by bloody stools or excessive secretions.

1. Symptoms of anal fistula

1. Itching: Due to the continuous stimulation of pus to the skin around the anus, it often feels itchy, damp and uncomfortable around the anus, skin discoloration, epidermal exfoliation, fibrous tissue hyperplasia and thickening, and sometimes eczema.

2. Pain: When the fistula is unobstructed and there is no inflammation, there is usually no pain. Only local swelling and discomfort are felt, which worsens when walking. When the fistula becomes infected or pus is not draining properly and becomes swollen and inflamed, it can cause pain. Internal fistula often causes burning discomfort in the lower rectum and anus, and pain when passing stool.

3. Pus discharge: It is the main symptom of anal fistula. The amount of pus is related to the length and number of the fistula. Newly formed fistulas have a greater inflammatory reaction and more pus discharge. The pus is thick, yellow, and has a foul odor. For long-term fistulas, the pus discharge is less, or sometimes there is pus, and sometimes there is no pus. The pus is white and thin like water.

4. Difficult defecation: If a complex anal fistula does not heal for a long time, it may cause the formation of large fibrotic scars or ring-shaped cords around the anus and rectum, affecting the dilation and closure of the anus, making defecation difficult and causing a feeling of incomplete defecation.

2. Symptoms of internal hemorrhoids

Stage I internal hemorrhoids are slightly painful, with symptoms mainly including blood in the stool, excessive secretions, and itching. Stage II internal hemorrhoids have blood in the stool, and the hemorrhoids prolapse with defecation, but can return to their original position on their own. Stage III internal hemorrhoids are also called late stage internal hemorrhoids. The internal hemorrhoids prolapse outside the anus, or fall out of the anus with every bowel movement, cannot return to their original position on their own, and must be manually supported. Stage IV internal hemorrhoids prolapse out of the anus and cannot be returned to the inside of the anus. This is the most serious condition of internal hemorrhoids.

3. Symptoms of external hemorrhoids

Painful lumps appear at the anal margin. The pain is severe at first, making walking difficult and the patient restless. The pain subsides after a few days and the lumps become soft. Connective tissue external hemorrhoids are often asymptomatic, with occasional anal itching, a feeling of loss or foreign body, and pain may occur if there is an infection.

4. Symptoms of mixed hemorrhoids

The main symptoms of mixed hemorrhoids are blood in the stool and/or anal distension and pain. Initially, the toilet paper is stained with blood, and occasionally dripping and spurting blood is seen. In the late stage, the hemorrhoids prolapse after defecation. In mild cases, they can be reduced by themselves, while in severe cases, they need to be pushed back by hand. There is a local foreign body sensation, and there are also symptoms such as constipation or uncomfortable defecation. It often occurs in the right front, right back and left side of the anus.