Private haemorrhoids and anal fissure clinic in London, same-day gastroenterology.

Telling them apart

• Haemorrhoids — swollen blood vessels inside or at the edge of the anus. Painless bright red bleeding, itching, a feeling of fullness, sometimes a lump that appears on opening the bowels and slips back.
• Anal fissure — a small tear in the lining. Sharp, tearing pain during and for some time after passing stool, often described as passing glass, with a small amount of bright blood. The pain is the distinguishing feature.
• Thrombosed pile — sudden severe pain with a hard purple lump at the anal margin. Very painful for a few days, then settles over a fortnight.

The treatment that matters most

Creams soothe; soft stools cure. Nothing else works reliably until the straining stops.

1. Increase fibre steadily — wholegrains, fruit, vegetables, beans and lentils. Increase gradually to avoid bloating.
2. Drink more water, particularly as you increase fibre. Fibre without fluid makes constipation worse.
3. Use a stool softener or bulking agent if diet alone is not enough. Aim for stools that pass without effort.
4. Do not strain, and do not sit for long periods on the toilet. No phones. Two or three minutes, then get up and come back later.
5. Use a footstool so your knees are higher than your hips — this straightens the passage and dramatically reduces straining.
6. Go when you get the urge. Delaying makes stools harder.

Symptom relief

• Warm baths, or sitting in a few inches of warm water, for 10 to 15 minutes several times a day — particularly effective for fissure pain, as it relaxes the muscle spasm that keeps the tear open.
• Over-the-counter creams and suppositories ease itching and discomfort. Those containing a steroid should not be used for more than about a week.
• Paracetamol for pain. Avoid codeine, which causes constipation, and be cautious with anti-inflammatories if bleeding.
• Keep the area clean and dry; wash with water rather than soap, and pat dry. Moist toilet tissue can irritate.
• Prescription ointment for fissures relaxes the internal muscle and allows healing. It works, but it needs using consistently for six to eight weeks, and headaches are a common side effect in the first few days.

When more is needed

Haemorrhoids that continue to bleed, prolapse or cause symptoms despite good bowel habit can be treated in clinic with rubber band ligation or injection, both quick outpatient procedures. Larger or persistent ones may need a surgical procedure. Fissures that have not healed after eight weeks of correct treatment may need a small operation or an injection to relax the muscle.