Difference Between Piles and Anal Fistula

June 28, 2025

Piles and Anal Fistula rank among the most common anorectal conditions globally, affecting millions and interfering daily activities. India leads the world with a recorded 11.0% of the Indian population impacted by piles. On the contrary, the cases of anal fistula are lower in Western countries but about 100 new cases are diagnosed per million every year in India. When it comes to piles vs fistula symptoms, many people assume they are dealing with the same issue, leading to delayed or incorrect treatment. So, read on to clear up the confusion and learn the differences to understand what your body might be trying to tell you.

What Are Piles (Haemorrhoids)?

Piles (haemorrhoids) are inflamed veins in the anal canal or around the anus, which are internal (within the rectum) or external (below the skin around the anus). They are most often the result of straining at stool, pregnancy, obesity, or prolonged sitting.

A physical examination normally may comprise a digital rectal examination and inspection to check for external or internal swelling. For internal piles, proctoscopy or anoscopy can be employed to offer a better view of the anal canal. However, colonoscopy is done if there is suspicion of other conditions or to exclude more severe diseases.

What is Anal Fistula?

An anal fistula also termed fistula-in-ano is an unusual tube at the end of the anal canal and outside skin of the anus, as a result of an infection or abscess formed in an anal gland. The abscess drains through the skin leaving behind a small fistula (opening) creating a pathway to the skin connecting the anal canal. It may also occur with conditions such as Crohn's disease (a chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract), tuberculosis, or trauma. Diagnosis of anal fistula is conducted by identifying an external opening and tracing the tract during a physical exam.

Causes and Risk Factors: Piles vs Anal Fistula

Piles and anal fistula are common anorectal disorders caused by different factors influenced by specific risk factors and lifestyle habits.

Factors Piles(Haemorrhoids) Anal Fistula

Causes

Long-standing constipation,
Straining on the bowel,
Diarrhoea, pregnancy,
Less fibre intake, and
Obesity

All interfere with normal circulation and result in venous engorgement.

Blocked and Infected Anal Gland
Cryptoglandular Infection refers to an infection in the tiny glands inside the anus wihin the canal

Less Common Causes:

Trauma (injury near the anal area)
Crohn’s Disease is an inflammatory bowel disorder accompanied by pain, diarrhoea and fatigue
Cancer (Malignancy)
Previous Radiation Therapy

Risk Factors

Age over 40,
Male gender,
Low dietary fibre intake,
Chronic constipation or diarrhoea,
Prolonged sitting,
Sedentary lifestyle,
Obesity,
Pregnancy,
Family history,
Poor hydration,
Hypertension,
Diabetes, and
History of straining during bowel movements.

History of perianal abscess,
Crohn's disease or
Other inflammatory bowel diseases,
Tuberculosis,
Diabetes,
HIV infection,
Trauma,
Anorectal surgery,
Smoking,
Obesity,
Inactivity, and
Complex fistula tracts
More common in men aged 20- 40.

Symptoms and Clinical Presentation

Piles vs fistula symptoms often look alike, but they have differences. This table shows the main signs and symptoms to help you understand how to identify piles and fistula:

Symptoms Piles(Haemorrhoids) Anal Fistula
Pain	Pile pain is typically mild except when a haemorrhoid is thrombosed or prolapsed (sharp or aching pain, particularly when sitting or on defecation).	Anal fistulas tend to result in throbbing, persistent pain near the anus and can make bowel movement, sitting, or walking painful.
Bleeding	Bright red, painless bleeding during bowel movements(a sign of internal haemorrhoids. Injury trauma or irritation to swollen veins in the anal canal are some reasons.	Tender, swollen, or hard bumps form around the anus, usually due to inflammation, and abscess.
Swelling/ Lumps	Sensitivity or pain on lumps in the anus area, typically due to swelling of the haemorrhoidal tissue or blood clots, leading to fullness.	Swelling in a blocked or infected tract is common due to inflammation, abscess, or the fistula tract, making the skin tender, warm, or hard.
Discharge	Mucous discharge from prolapsing or large internal piles leads to perianal moisture, soiling, apparel and perianal inflammation or discomfort.	Ongoing pus, blood, or stool leakage from the outside opening, usually with a bad odour and staining of underwear.
Itching/ Irritation	Chronic itching and irritation resulting from mucous discharge and inability to keep the area clean due to swelling.	The constant drainage irritates the skin, leading to itching, redness, and an urge to keep scratching the area.
Fever/ General Illness	Fever is uncommon but may be present if a haemorrhoid is infected or an abscess forms and needs emergency treatment.	An infected fistula or abscess results in fever and malaise, indicating the need for prompt treatment.

How Piles and Anal Fistulas Differ in Complications

"Is fistula more serious than piles?" To answer this, it is important to know how piles and anal fistulas are different when it comes to risks like blood clots, infections, skin changes losing control of bowel movements and cancer. This explains why doctors often need to treat fistulas more.

Complication Piles(Hemorrhoids) Anal Fistula
Thrombosis	Painful clots in external piles	Not applicable
Infection	Rare	Persistent infection, abscess formation
Skin Tags/ Stenosis	Possible after healing	Possible after surgery or chronic disease
Faecal Incontinence	Occurrence is rare, usually after surgery	This can be possible if the fistula involves sphincter muscles
Cancer Risk	Extremely rare	Slightly increased with chronic, untreated disease

Treatment Approaches: Piles vs Anal Fistulas

Doctors choose to treat piles and anal fistulas based on the severity of the condition and the underlying cause. For mild cases, treatment options for piles and fistulas often start with simple non-invasive methods, while long-lasting issues might need minor procedures or surgery.

Treatment Approach Piles(Hemorrhoids) Anal Fistula
Dietary Habits	Doctors recommend that patients eat more fibre, drink more water, use stool softeners, put on special creams, and take warm baths. These treatments help reduce discomfort and prevent haemorrhoids from coming back.	Almost equally, the same treatment approach as that of treating piles, combined with good hygiene. Don’t neglect medical treatment, which is usually necessary.
Alternate Approach	Rubber Band Ligation: A small band is wrapped around the base of the haemorrhoid to cut off its blood supply, causing it to shrink and fall off. Injection (Sclerotherapy): A chemical solution is injected to shrink the haemorrhoid. Excision or Surgical Removal: The haemorrhoid is cut out during a minor surgical procedure. Shrinking Treatments: Doctors may use medication or other techniques to reduce the size of haemorrhoids.	Non-Surgical Methods (Less invasive, but less effective) Fibrin Glue: A special glue is injected to seal the fistula. Fistula Plug: A small device is inserted to block the tract and help heal. Surgical Options (More effective for long-term results) Fistulotomy: The fistula tract is surgically opened and cleaned; it heals naturally from the inside out. Seton Placement: A surgical thread is placed to drain the infection slowly. Advancement Flap Procedure: Healthy tissue functions to close off the fistula's internal opening.
Surgical Intervention	For unresponsive piles (big piles having blood clots), surgery options, including excision, stapling, or lasers, may help.	Fistulotomy, fistulectomy, and seton placement or using special flap techniques, guided by imaging are various options for surgical interventions to avoid anal fistula.
Prevention and Lifestyle Modification	Major preventions can be achieved through a fibre-rich diet, water, exercise, and avoiding straining or prolonged sitting.	Proper anal hygiene and treating infection early are the best ways to eliminate anal fistula. You must control underlying diseases such as Crohn's to prevent risk and recurrence associated with piles and anal fistula.

Ease Discomfort, Consult Apollo today!

Piles and fistulas can disrupt an individual's normal activity. You must familiarise yourself with the key differences for proper diagnosis and prompt treatment. Understanding between Piles or fistula, which is painful, will depend on your symptoms, diagnosis, complications and treatment. In some cases, anal fistulas tend to cause more disabling and chronic pain with infection or abscess, however, both conditions will call for medical intervention if not taken care of. Following healthy lifestyle practices and achieving early medical treatment can successfully manage these ailments.

You can restore comfort and confidence to your lifestyle. Don’t let discomfort hold you back; book an appointment with a specialist today at Apollo Spectra for personalised care and long-term relief.