Hemorrhoids and anal fissures

The lists below come from public pages opened on October 25, 2026. Matching a sentence does not identify which one you have. ahem does not examine people.

Mayo Clinic calls hemorrhoids swollen veins in the lower rectum. On the symptoms page dated August 23, 2025, internal hemorrhoids are usually painless and tend to bleed. External hemorrhoids may cause pain. NIDDK, last reviewed in October 2016, says external hemorrhoids may itch, form hard tender lumps near the anus, or ache, especially when sitting. Internal hemorrhoids may leave bright red blood on stool, on toilet paper, or in the toilet bowl, and they most often are not painful unless they prolapse.

Mayo Clinic's fissure page, dated December 31, 2024, calls an anal fissure a small tear in the thin, moist tissue that lines the anus. MedlinePlus, reviewed April 11, 2026, calls it a small split or tear in that lining. NIDDK's diagnosis page uses the same idea when it tells a doctor what to look for: a small tear in the anus that may cause itching, pain, or bleeding. NIDDK lists that tear separately from a prolapsed hemorrhoid and from a clot.

On the page checked October 25, 2026, Mayo Clinic lists pain during bowel movements, pain after bowel movements that can last up to several hours, bright red blood on the stool or toilet paper, a visible crack in the skin around the anus, and a small lump or skin tag near the tear. It also says spasms can occur in the anal sphincter, the ring of muscle at the end of the anus.

MedlinePlus says a fissure may cause painful bowel movements and bleeding, with blood on the outside of the stool or on toilet paper. It says the crack is almost always in the middle, and that it can be seen when the area is stretched slightly. It says symptoms may start suddenly or develop slowly. It also says that avoiding bowel movements because of the pain makes stools harder, which can make the tear worse.

Mayo Clinic says to see a health professional for pain during bowel movements, or for blood on stools or toilet paper after a bowel movement. That is a lower bar than waiting to see if a cream works. The bleeding page has the emergency signs Mayo Clinic names for a large amount of blood.

Both problems can involve bright red blood and anal pain. A skin tag can sit near a fissure, and NIDDK says a skin tag can also be leftover skin after a clot in an external hemorrhoid dissolves. A hard lump can be the clot Mayo Clinic describes. None of those details picks a winner from a bathroom mirror.

NIDDK says a doctor often makes the hemorrhoid diagnosis from the history and an exam, and looks for a fissure on that exam. The steps are on what a hemorrhoid exam checks. When rectal bleeding should be checked is the page for the bleeding itself, including the reasons both sources give for not treating it as a hemorrhoid by default.

Mayo Clinic says most anal fissures get better with simple treatments such as more fiber or a warm-water bath, and that some people need medicine or surgery. MedlinePlus says most fissures heal on their own. For children and adults it describes more fiber, more fluids, and stool softeners, so stools stay softer. On the page reviewed April 11, 2026, it describes a sitz bath as sitting in warm water 2 to 3 times a day for 10 to 15 minutes, with the water covering the hips and buttocks.

If home care does not resolve the tear, MedlinePlus says treatment may involve a prescription cream, an injection into the sphincter, or minor surgery. It names nitrates and calcium channel blockers as examples of those creams, and botulinum toxin as the injection. Those are clinician treatments. This page does not explain how to use them.

Fiber and fluids for hemorrhoid symptoms have their own page, fiber, fluids, and hemorrhoid symptoms. The warm-bath timing Mayo Clinic gives for hemorrhoids is on what actually helps with hemorrhoids. The fissure bath above is the MedlinePlus description, checked the same day.