Diseases of the “bottom”—piles, fissure, fistula, and pilonidal sinus—cause anxiety, confusion, and embarrassment for millions of Indians. These conditions produce overlapping symptoms like pain, bleeding, swelling, and discharge around the anus, making it difficult for most people to self-diagnose before seeing a specialist. This practical, patient-friendly guide explains each condition in simple language, with checklists and real examples to help you recognize your problem before your consultation.
Why Is There So Much Confusion?
These are diseases of the bottom that make it very confusing for common people to diagnose themselves. Because all involve the same zone, even doctors sometimes require special tests to distinguish them. To make it simple, here’s how piles, fissure, fistula, and pilonidal sinus differ, with easy signs you can use at home.
Overview Table
| Condition | Key Symptom(s) | Where It Is | Unique Feature |
| Fissure | Burning pain after stool, minor bleeding | Inside anus (anal canal) | Caused by tear/strain, burning > bleeding |
| Piles (Hemorrhoids) | Painless bleeding on stool, swelling, discomfort | Anal edge (internal/external) | Bulging veins, like varicose veins; may feel lump |
| Fistula-in-ano | Pus discharge, recurring pimple | Skin near anus | Draining canal, history of old abscess |
| Pilonidal Sinus | Pus discharge between buttocks, little pain | Lower back crease (not in anus) | Tunnel above buttocks, hairs/debris inside |
Fissure: The Painful Tear
- What is it?
A fissure is a painful crack or tear in the anal lining, usually caused by passing a large or hard stool, constipation, or sometimes diarrhea. The lining splits, causing sharp, burning pain during and after passing stool. - Symptoms:
- Intense, burning pain after stool
- Bright red bleeding (streaks on toilet paper)
- May feel spasms/anxiety to pass stool again
- Why it happens:
Often from big or hard stool, forcing/stretching, or repeated straining. - What to look for:
- Pain is the key (bleeding is mild and follows pain)
- Common in all age groups, from toddlers to adults
Piles: The Swollen Veins
Piles are bulged veins like varicose veins. They are divided into internal and external types:
- External piles: Covered with skin at anal verge (the outer rim)
- Internal piles: Covered with inner pink mucosa, similar to the bulging blood vessels below your tongue.
What happens in piles?
- When these veins bulge outward, sometimes blood may clot within, causing pain or swelling.
- Most often, internal piles produce painless bleeding—a splash of bright red blood in the toilet or on tissue.
- Swelling around the anus is a classic sign, especially with external piles.
Symptoms:
- Bleeding while passing stool, usually painless (internal)
- Feeling of a lump or swelling at anal opening (external)
- Discomfort when sitting, sometimes mild pain if thrombosed (clotted)
Fistula in Ano: The Draining Canal
Fistula in ano is a disease that usually follows a perianal abscess (collection of pus).
- How does it form?
When stool particles and bacteria find their way through a weak spot or after infection, a pus-filled swelling (abscess) develops near the anus. If the abscess bursts spontaneously or after drainage, it can leave a tunnel (canal) connecting the internal opening (in the anal canal) to an external opening in the skin near the anus. - Symptoms:
- Intermittent pus or foul-smelling discharge around anus
- A persistent or recurring small pimple that drains every few weeks (15–20 days between episodes)
- Sometimes, mild pain or irritation before pus discharge; pain often settles after
- Rare blood or stool in discharge
Pilonidal Sinus: Tunnel at the Tailbone
Pilonidal sinus is a disease on its own, not directly related to problems inside the anus.
- What is it?
A small tunnel under the skin in the crease between your buttocks, just above the anal region (lower back/sacrum area). Usually filled with hairs or debris that cause infection. - Symptoms:
- Pus-draining small canal between buttocks (not anus)
- Rarely painful, but may be tender if infected or swollen
- Oozing of pus, occasional foul-smell
- A pimple or pit at the center of the crease
- Who gets it?
Young men, people with dense or coarse hair, sedentary workers, or those with a history of repeated irritation/friction in the area.
These are the diseases of the bottom, which makes it very confusing for common people to get diagnosed themselves.
To make it simple, Piles, Fissure, Fistula, and Pilonidal Sinus are simply explained here:
- Fissure: Burning pain after passing stool, due to an initially big size or hard stool with minor rubbing and bleeding. Classic fissure.
- Piles: Bulged veins like varicose veins, divided into internal and external. External piles are at the anal verge (skin), while internal piles are covered with inner pink mucosa, like the Venus bulge below the tongue. They may cause a swelling, pain if clotted, or just bleeding if internal.
- Fistula in ano: Comes after an abscess. Internal motion particles and bacteria create pus swelling. Burst abscess creates a canal with internal and external openings. Patient experiences a small pimple draining pus every 15-20 days.
- Pilonidal sinus: Causes pus-draining canal in the buttock crease (lower back), rarely painful, main symptoms being pus discharge and discomfort.
How to Self-Screen (Before You See A Doctor)
Below is a quick checklist to help you guess which bottom disease you may have before meeting a specialist:
| Feature | Fissure | Piles | Fistula | Pilonidal Sinus |
| Bleeding | Mild, after pain | Painless/profuse | Rare (with pus) | Rare, usually pus only |
| Pain | Severe, burning | None/mild if clotted | Dull, before discharge | Occasional, if infected |
| Lump/Swelling | No (maybe spasm) | Yes (feels soft or hard) | Small, may open/drain | Lump/pit at tailbone crease |
| Pus Discharge | Rare | No | Yes, intermittent | Yes, persistent or recurrent |
| Main Clue | Sharp pain | Blood/lump | Recurring pus pimple | Pus in lower back (not anus) |
Key Differences
- Location matters:
- Fissure/piles/fistula: around or in the anus
- Pilonidal sinus: higher up, between buttocks, never from the anal opening
- Symptoms rotate:
- Bleeding: piles and fissure (rare in others)
- Pain: fissure (sharp), piles (mild), fistula (mild, more with pus), pilonidal sinus (rare, mainly if infected)
- Pus: fistula and pilonidal sinus
When to Seek Medical Help
- Persistent pain or bleeding, any pus discharge, or new swelling/lump
- Fever, severe pain, redness spreading around the bottom/low back
- Unable to sit, repeated recurrence, or non-healing “pimple”
FAQ
- Can I treat these conditions at home?
Mild piles and fissures often improve with fiber, fluids, and creams. Fistula and pilonidal sinus need surgical evaluation—don’t wait for self-healing. - Are all piles dangerous or lead to cancer?
No. Most are benign. However, routine care and screening are advisable, especially after age 50 or if symptoms persist. - Will these conditions recur after treatment?
Sometimes—lifestyle and preventive changes reduce recurrence. Complete healing for fistula or sinus often requires minor surgical procedures.