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Piles and anal fissures are common anorectal problems which affect people of all ages. These conditions mostly arise as a result of poor dietary habits, sedentary lifestyle and chronic constipation giving rise to straining at stools.

Piles are engorged blood vessels of the anal canal which mostly present with painless bleeding. This bleeding is bright red, copious and occurs as a small jet or splash after passing stools. There can also be protrusion of the piles mass in case of large and long standing piles. Pain is uncommon and is usually a symptom of complicated piles like with thrombosis or strangulation.

Fissure in Ano is a ulcer or crack in the lining of the anal canal which presents with painful defacation. There may be associated burning and itching in the anal area and bleeding occurs which is typically a thin streak of blood on the side of stools. In case of chronic fissure, there are single or multiple skin tags which form as a result of swelling of perianal skin at the lower end of the fissure. These are also known as sentinel piles but are different from actual piles masses.

The treatment of piles and anal fissures is also different. Conservative treatment of piles involves Sitz baths, laxatives, anti hemorrhoidal creams and some medications to stop bleeding. Surgery for piles can be open surgery, stapler Hemorrhoidectomy or using laser.

On the other hand, conservative treatment of fissure also involves sitz baths and laxatives along with numbing anaesthetic jelly to relieve the pain. Local application of nitrogesic ointment helps to relieve the anal spasm and facilitate healing of the fissure. In chronic fissure, treatment involves partial cutting of the internal sphincter muscle along with removal of the skin tags. This css as n be done by conventional surgery or by using laser.

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