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Hemorrhoids and anal fissures

What are hemorrhoids?

The hemorrhoid veins are part of the locking mechanism of the rectum and are responsible for sealing the anus. The sealing works through different levels of filling of the blood vessels. If these vessels do not inflate and deflate properly and cause problems, it is called hemorrhoids.

What are the symptoms of hemorrhoids?

  • Anal bleeding
  • Mild fecal soiling
  • In case of existing sensitivity:
    • anal itching
    • anal burning

What is an anal fissure?

An anal fissure is a crack in the anal canal. Most anal fissures are caused by stretching the anal mucosa beyond its capability. Pain causes additional tenseness of the anal opening which reduces its opening volume even more. Scars may develop and further decrease the elasticity of the anus.

What are the symptoms of anal fissures?

  • Weeping and fresh blood on the toilet paper
  • In case of existing sensitivity:
    • pain when defecating, potentially long lasting
    • anal itching


Hemorrhoids and anal fissures cannot always be avoided; however, if some simple rules are followed, their occurrence can be reduced:
  • regular defecation, every 1-2 days
  • preventing constipation or hard stool
  • only as many digital manipulations of the rectum as necessary; carry out carefully and use sufficient Vaseline

What do I do if I suffer from problems due to hemorrhoids or anal fissures?

  • Regulation of stool consistency – it should be soft and depends on:
  • Hemorrhoids
    • local treatment using hemorrhoid paste or suppositories
  • Anal fissures
    • if painful, a local anesthetic paste may be used
    • good personal hygiene, possibly warm hip-baths

If hemorrhoids are too big or cause too much discomfort, surgery becomes necessary. The enlarged vessels are normally ligatured with an elastic band or atrophied.


Is blood in the stool generally caused by hemorrhoids or anal fissures? Is this always harmless?
No, a change in the bowel can also be the reason for it. You should consult your GP when a bleeding occurs for the first time.

Is it dangerous if it is bleeding strongly?
Usually not – hemorrhoids can bleed severely. However, if the bleeding continues , you should inform your GP.

About the authors:

  • Christa Schwager is a specialist in movement science in the Department for Nursing Development and Education at the Swiss Paraplegic Centre in Nottwil/Switzerland, where she has worked since 1994. She is co-author of the key publications in the field of spinal cord injury "Paraplegie. Ganzheitliche Rehabilitation" (eds. Guido A. Zäch & Hans Georg Koch) and "Pflege von Menschen mit Querschnittlähmung" (ed. Ute Haas).
  • Karin Roth is advanced practice nurse in the Department for Nursing Development and Education at the Swiss Paraplegic Centre, where she has worked since 1997. She is also co-author of the key publication in the field of spinal cord injury "Pflege von Menschen mit Querschnittlähmung".
  • The article is the result of a collaboration with the panel of experts in bowel management of the Swiss Paraplegic Centre.

updated: December 2013