Symptoms

01 August 2026

Pain During Bowel Movements: Haemorrhoids vs Anal Fissures

Haemorrhoids and anal fissures are two common causes of anal pain and bleeding, but they differ in key ways. Haemorrhoids usually cause dull pressure, swelling, and bright red bleeding, while anal fissures cause sharp, “cutting” pain and discomfort that may last for hours after bowel movements. Understanding these differences helps guide appropriate care and when to seek specialist advice.

This guide explains how to tell the difference and when to seek specialist care in Singapore.

Introduction

Experiencing pain, discomfort, or bleeding during bowel movements can be distressing. Many patients in Singapore often wonder whether their symptoms are caused by haemorrhoids (piles) or an anal fissure.

Although these two conditions share similar symptoms, they are fundamentally different. Understanding the key differences can help you recognise your condition earlier and seek appropriate care.

If you are also experiencing bleeding, you may refer to Blood in Stool: 7 Possible Causes You Should Not Ignore for a broader understanding of possible conditions.

Why Are Haemorrhoids and Anal Fissures Often Confused?

Haemorrhoids and anal fissures are both common causes of anal discomfort and bleeding. Because they affect the same area, their symptoms can appear similar at first.

Both conditions may present with:

Pain during bowel movements
Bright red bleeding
Discomfort when sitting

However, the type of pain, pattern of bleeding, and underlying cause are different. Understanding these differences is important, as each condition requires a different treatment approach.

Key Differences Between Haemorrhoids and Anal Fissures

What is the difference between haemorrhoids and anal fissures?

The table below summarises the key differences for easier comparison:

Feature	Haemorrhoids	Anal Fissures
Type of Pain	Dull, heavy, or burning discomfort; pressure or swelling	Sharp, “knife-like” pain during bowel movements
Duration of Pain	Usually improves after passing stool	May last for hours after bowel movement
Bleeding Pattern	Bright red blood dripping into bowl; separate from stool	Small streaks of blood on toilet paper or stool
Presence of Lump	Soft lump or swelling; may protrude	Usually no lump; may have small firm skin tag
Muscle Spasm	Rare	Common; tight or “clenching” sensation
Common Causes	Straining, prolonged sitting, pregnancy, diarrhoea	Constipation, hard stool, anal trauma

Type of Pain: Sharp vs Dull

Haemorrhoids:

Dull, heavy, or burning discomfort
Sensation of pressure or swelling

Anal fissures:

Sharp, “knife-like” pain
Sudden tearing sensation during bowel movements

Duration of Pain

Haemorrhoids:

Pain usually improves after passing stool
Mild discomfort may persist

Anal fissures:

Pain may last for hours after bowel movements
Often associated with ongoing muscle spasm

Bleeding Pattern

Haemorrhoids:

Bright red blood dripping into the toilet bowl
Blood appears separate from the stool

Anal fissures:

Small streaks of blood
Blood seen on toilet paper or coating stool

If you notice blood during bowel movements and are unsure of the cause, you may read more in Rectal Bleeding: When Is It Serious and When to See a Colorectal Surgeon.

Presence of a Lump

Haemorrhoids:

Soft lump or swelling
May protrude during bowel movements

Anal fissures:

Usually no visible lump
May develop a small, firm skin tag (sentinel tag)

Muscle Spasm and Tightness

Haemorrhoids:

Typically no muscle spasm
Discomfort is more pressure-related

Anal fissures:

Persistent tightness or “clenching” sensation
Cramping and difficulty relaxing after bowel movement

Common Causes and Triggers

Haemorrhoids are commonly linked to:

Chronic straining
Prolonged sitting
Pregnancy
Frequent diarrhoea

Anal fissures are often caused by:

Passing hard stools
Constipation
A single traumatic bowel movement

When to Seek Medical Attention

You should consider medical evaluation if you experience:

Persistent pain or bleeding
Symptoms lasting more than a few days
Difficulty passing stool due to pain
Recurrent symptoms

Even if symptoms appear mild, proper assessment is important to confirm the diagnosis. You may consider consulting a colorectal specialist for further evaluation.

How Is the Diagnosis Confirmed?

A colorectal specialist may perform:

Physical examination
Digital rectal examination
Further evaluation if required

In some cases, a colonoscopy may be recommended to identify the source of bleeding or rule out other conditions.

Frequently Asked Questions

If I don’t feel a lump, does that mean it is a fissure?

Not always. Internal haemorrhoids may not be felt externally.

Can I have both haemorrhoids and an anal fissure?

Yes, both conditions can occur together.

Why does pain last for hours after bowel movement?

This is more commonly associated with anal fissures due to muscle spasm. However, painful external swelling may also indicate a thrombosed external haemorrhoid.