Piles, fissure and fistula

Common signs

When to see a surgeon

• Bright red blood on the toilet paper or in the pan (piles)
• Sharp pain while passing stools, lasting for some time afterwards (fissure)
• A swelling that comes out while passing stools (piles)
• Pus or wet discharge from an opening near the anus (fistula)

Go to an emergency department now if you have heavy bleeding, or a very painful hot swelling with fever near the anus (abscess).

Treatment

What can be done

Piles: more fibre, more water and not straining help most people. Medicines, banding or other day-care procedures, or surgery are used when piles keep bleeding or come out.

Fissure: most heal with soft stools, warm sitz baths and ointments that relax the muscle. A fissure that does not heal may need a small procedure.

Fistula: a fistula does not heal with medicines. It needs surgery, planned so that control of stools is protected. An MRI is sometimes done first.

Bleeding from the back passage is not always piles. If you are over 40, or have weight loss or a change in bowel habit, a colonoscopy may be advised to rule out other causes.