Medically reviewed by: Hospital medical team Last reviewed: 2026
Two different conditions
Piles, also called haemorrhoids, are enlarged vascular cushions in or around the anus. An anal fissure is a small tear in the lining of the anal canal. Both can cause bright red bleeding, but they are different conditions and may need different treatment. They can also occur together. People sometimes use the word piles for any anal symptom, which can delay the correct diagnosis. Bleeding should not automatically be attributed to either condition without considering other possible causes.
Recognising common symptoms
Internal haemorrhoids may cause painless bleeding or tissue that protrudes during a bowel movement. External swelling can cause irritation, and a clot in an external haemorrhoid can be painful. A fissure more often causes sharp pain while passing stool, followed by burning or aching that can continue afterwards. Hard stools and straining can contribute, but frequent loose stools may also irritate the area. Itching, discharge or persistent pain may have other explanations, including skin problems or infection, and deserve an assessment if they continue.
What assessment may involve
A doctor will ask about bleeding, pain, bowel habits, medicines and any family history of bowel disease. An examination may include looking at the area and, when appropriate, a gentle rectal examination or a short scope examination. Severe fissure pain may change how the examination is performed. Further bowel tests depend on your age, symptoms and risk factors rather than a label of piles alone. Mention weight loss, tiredness, a change in bowel habit or blood mixed into stool, not only blood on the paper.
Bowel care and treatment options
Keeping stools soft is often an important first step. Increase dietary fibre gradually, drink appropriate fluids and avoid prolonged sitting or straining on the toilet. Fluid advice may differ if you have heart or kidney disease. Warm shallow baths may soothe discomfort. A clinician may recommend a stool-softening medicine or a short course of symptom relief. Persistent fissures sometimes need prescription ointments, injections or surgery. Haemorrhoids may be treated with office procedures or surgery when needed. The choice depends on examination findings, symptoms and treatment risks.
When not to wait
Arrange a medical review for new, recurrent or unexplained rectal bleeding, even when the amount seems small. Heavy bleeding, faintness, black tarry stool or severe weakness needs urgent care. Constant worsening anal pain with fever or swelling may indicate an abscess rather than piles and also needs prompt assessment. Avoid repeatedly using steroid creams or taking antibiotics without advice. If symptoms persist despite bowel care, return for review rather than assuming the diagnosis is settled. Many causes are treatable once the problem is correctly identified.
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References
This information is for general awareness and does not replace advice from a qualified doctor.