Fistula vs Fissure: A Complete Comparison Guide
                     Fistula vs. Fissure: 
Understanding the 
Difference
Anorectal conditions can cause significant discomfort, yet many 
patients—and sometimes even doctors—confuse anal 
fistulas and fissures. Though both affect the same area, they have 
different causes, symptoms, and treatments. Understanding these 
differences is crucial for proper diagnosis and effective treatment.
What Is an Anal Fissure?
Definition
A small tear in the lining of the anal canal, exposing sensitive nerve 
endings
Causes
Chronic constipation, passing hard stools, or prolonged diarrhea
Symptoms
• Sharp, burning pain during or after bowel movements
• Visible blood on toilet paper
• Anal muscle spasms
• Persistent discomfort lasting hours
What Is an Anal Fistula?
Definition
An abnormal tunnel between the inner anus and surrounding skin
Causes
Develops due to infection or abscess near the anal glands
Symptoms
• Persistent pain
• Swelling near the anus
• Pus or fluid discharge
• Recurring infections or fever
Key Differences: Fistula vs. Fissure
Feature Anal Fissure Anal Fistula
Cause Tear due to hard stool Infection leading to abscess
Symptoms Sharp pain, bleeding Discharge, persistent pain
Appearance Small crack in anal lining External opening or swelling
Duration May heal naturally Needs surgical treatment
Treatment Topical creams, surgery Surgery, drainage procedures
Knowing these differences is crucial when seeking appropriate treatment for your condition.
Diagnosis Process
Physical Examination Advanced Diagnostic Tools
Doctors start with a thorough examination: For complex cases, especially fistulas:
• Fissure: Often visible as a small tear • Anoscopy
• Fistula: May require deeper inspection to locate the • MRI scans
tract • Endoanal ultrasound
These methods help map the fistula's path before 
recommending treatment.
Treatment Options for Fissures
Conservative Management Advanced Procedures
• Increased fiber intake • Botox injections to relax muscles
• Proper hydration • Lateral internal sphincterotomy for chronic cases
• Sitz baths
• Topical medications
Most acute fissures heal within 4-6 weeks with proper care. The best approach ensures tailored treatment for faster 
healing.
Treatment Options for Fistulas
Unlike fissures, fistulas rarely heal without surgery. Several surgical techniques are available:
Fistulotomy Seton Placement
Simple procedure for uncomplicated fistula tracts For complex fistulas, using a thread to gradually cut 
through
Laser Fistulotomy LIFT Procedure
FILAC technique using laser technology for minimal Ligation of intersphincteric tract for complex cases
invasiveness
Recovery typically takes 4-8 weeks depending on the fistula's complexity.
Prevention and When to Seek Help
Prevention Tips When to See a Specialist
• Maintain proper hydration Seek medical attention if you experience:
• Eat fiber-rich foods • Persistent anal pain
• Avoid straining during bowel movements • Bleeding during bowel movements
• Address constipation promptly • Swelling or discharge near the anus
Early intervention improves outcomes and shortens 
recovery time.
Dr. Daniel Serralta
Address Phone no. Website
C/o - Saudi German Hospital, +971 568 05 4323 Dr. Daniel Serralta
Hessa Street 331 West Al Barsha 
3, Exit - 36 Sheikh Zayed Rd - 
opposite of American School - 
Dubai