How to differentiate between anal fistula and hemorrhoids

Nov 11, 2025 Source: Cainiu Health

Dr. Li Jingxiang

Introduction

Anal fistulas and hemorrhoids can generally be differentiated based on aspects such as etiology, typical symptoms, lesion location, external appearance, and disease course characteristics. Anal fistulas are usually caused by incomplete healing after rupture of a perianal abscess, resulting in an abnormal channel (fistula) connecting the perianal skin to the rectum. Hemorrhoids, on the other hand, develop due to congestion and swelling of the venous plexus in the anal canal or lower rectum, often associated with prolonged sitting, constipation, increased intra-abdominal pressure, and similar factors.

Anal fistula and hemorrhoids can generally be differentiated based on factors such as cause, typical symptoms, lesion location, appearance, and disease course characteristics. A detailed analysis is as follows:

1. Cause: Anal fistulas are usually caused by incomplete healing after rupture of a perianal abscess, resulting in an abnormal channel (fistula) connecting the skin around the anus with the rectum. Hemorrhoids, on the other hand, develop due to congestion and swelling of the venous plexus in the lower rectum or anal canal, commonly associated with prolonged sitting, constipation, increased intra-abdominal pressure, and similar factors.

2. Typical Symptoms: The main symptoms of anal fistula include recurrent discharge of pus from the perianal area and pain; the pus may irritate the skin, causing itching, and symptoms tend to recur frequently. Common manifestations of hemorrhoids include painless bright red blood during bowel movements, protrusion of anal masses, and sometimes a sensation of heaviness or pain in the anal region. Discharge of pus is typically absent in hemorrhoids.

3. Lesion Location: Anal fistulas involve a fistulous tract with an internal opening (located within the rectum or anal canal) and an external opening (on the perianal skin), forming a complete passage. Hemorrhoidal lesions are concentrated in the lower rectum or anal canal and are classified into internal hemorrhoids (above the dentate line), external hemorrhoids (below the dentate line), and mixed hemorrhoids, without any fistula formation.

4. Appearance: In anal fistula, a fixed external opening can be observed on the perianal skin; pressing may result in pus discharge, and the surrounding skin may appear red and hardened. During hemorrhoid flare-ups, external hemorrhoids appear as purple or dark purple swellings at the anal margin, while prolapsed internal hemorrhoids present as soft, red masses. There is no obvious external opening or pus discharge in hemorrhoids.

5. Disease Course Characteristics: Anal fistula has a long disease course. If left untreated, it persists and is prone to recurrent infection and worsening, potentially leading to multiple fistulous tracts. Hemorrhoids often follow an intermittent course, with symptoms varying in severity over time. Symptoms can be alleviated through lifestyle modifications, and some patients may remain stable for extended periods without significant progression.

When experiencing perianal discomfort, it's important to carefully observe symptom characteristics and avoid self-diagnosis that might delay proper management. If symptoms persist or worsen, timely consultation with a specialist in proctology at a正规 medical institution is recommended.

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How long does it take for the hemorrhoid ligation band to fall off after surgery?

If postoperative care is properly managed—keeping the anal area clean and dry, avoiding strenuous activity and straining during bowel movements—the blood supply to the ligated tissue will gradually be cut off, leading to normal necrosis and detachment. Most individuals complete the shedding process within 7–14 days. During this period, minor rectal bleeding or mild sensation of heaviness may occur, which are normal phenomena. No special intervention is required; simply allow the tissue to detach naturally.

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Can patients with hemorrhoids eat Ejiao cake?

In general, patients with hemorrhoids can consume Ejiao cake, as long as they do so in moderation. It is important to control the portion size when eating Ejiao cake to avoid indigestion or increased gastrointestinal burden caused by overconsumption. Choose Ejiao cake with simple ingredients and minimal spicy or irritating additives to reduce stimulation to the intestines and hemorrhoids. If symptoms such as abdominal bloating, worsened constipation, or increased hemorrhoidal pain occur after consumption, discontinue use and consult a healthcare provider.

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Is hospitalization required after mixed hemorrhoid surgery?

In general, whether hospitalization is required after mixed hemorrhoid surgery depends on a comprehensive assessment of factors such as the surgical method, the patient's physical condition, and expected postoperative recovery. If any discomfort occurs, it is recommended to promptly consult the attending physician. Before deciding on hospitalization, patients should have thorough discussions with their doctor to fully understand the surgical procedure and their own health status. For those recovering at home after surgery, it is important to keep the surgical wound clean and dry.

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Can a colonoscopy detect internal hemorrhoids?

A colonoscopy can detect internal hemorrhoids, clearly revealing their location, size, number, and mucosal condition, while simultaneously screening for other intestinal abnormalities. If symptoms such as rectal bleeding, anal heaviness, abdominal pain, or changes in bowel habits occur, prompt medical evaluation is recommended. Internal hemorrhoids are located at the distal end of the rectum near the anus, and a colonoscope can be inserted through the anus into the rectum and colon to directly visualize the morphological characteristics of the hemorrhoids.