Even though the symptoms are comparable—pain, bleeding, and itching—the similarities between anal fissures and hemorrhoids are largely superficial. Hemorrhoids are generally swollen veins. In contrast, fissures are ulcers, or breaks in the skin, which just happen to occur in the same general area.
Research points to anatomical problems that can contribute to chronic anal fissures, as opposed to isolated problems with the painful lesions. Increased pressure in the internal anal sphincter muscle and reduced blood flow to the area in which fissures occur may make you more prone to chronic problems. If you have fissures, you know these little sores can make your life—at least your sitting life—miserable.
In severe, chronic cases, surgery may be required, but it carries considerable risks, including the possibility of fecal incontinence if the anal sphincter is injured. But according to Leff, some fissures will respond to Botox injections, eliminating the need for surgery.
And a number of nonsurgical remedies exist to help fissures heal. The anal opening was never meant to accommodate large, hard stools. Generally a by-product of a Western diet lacking in fiber, rock-hard stools tug and tear at the anal canal, which can result in anal fissures and hemorrhoids.
The solution? Adapt yourself to a diet high in fiber and fluids that produce soft bowel movements. Eating more fruit, vegetables, and whole grains, and drinking six to eight glasses of water a day are the best remedies and preventive measures you can use for anal fissures, says Leff.
