Dr PIYUSH GARUD. PROCTOMAX CLINIC, PIMPLE GURAV, 9096222036 While piles, fissures, and fistulas all affect the anal region, they are fundamentally different conditions: piles are swollen blood vessels, fissures are skin tears, and fistulas are abnormal tunnels. A quick breakdown of their core differences: Piles (Hemorrhoids) Swollen, inflamed veins in the anus and lower rectum. Painless, bright red bleeding, palpable lumps, and itching. Chronic constipation, straining during bowel movements, pregnancy, or heavy lifting. Fissures Small tears or cuts in the lining of the anal canal. Severe, sharp pain during and after bowel movements, and visible tears. Passing hard or large stools, chronic diarrhea, or trauma to the anal area. Fistula An abnormal tunnel connecting the anal canal to the skin near the anus. Persistent discharge of pus or blood, swelling, and localized pain. Usually results from a previous anal abscess (an infected cavity filled with pus). Treatment and Management • Piles & Fissures: Often treated conservatively first with high-fiber diets, stool softeners, topical creams, and warm sitz baths. If they are severe or chronic, minor procedures or surgeries may be needed. • Fistula: Treatment typically requires medical imaging (like an MRI) followed by surgery to safely drain the infection and close the tunnel without damaging the surrounding sphincter muscles.