Haemorrhoids are swellings in the upper anal canal and lower rectum due to engorgement of veins. May be internal
or external. Anal fissure is a tear in the lining of the lower rectum.


  • Constipation and straining in defecation
  • Portal hypertension from any cause
  • Compression of pelvic veins, e.g. abdominal tumours, pregnancy
  • Sedentary life style

Clinical features


  • Painless rectal bleeding
  • Visible swelling at the anus or prolapse of the swelling, especially at defecation
  • Blood is usually not mixed with stool but instead coats the surface of the stool or toiletry
  • Mucous discharge and irritation at anus

Anal fissure

  • Pain in passing stool
  • Bleeding at passing of stool

Differential diagnosis

  • Schistosomiasis, amoeboma
  • Rectal polyps, prolapsed rectum
  • Anal tags (harmless growths that hang off the skin around the outside of the anus)
  • Tumour of rectum
  • Anal warts


  • Visual inspection and digital rectal examination
  • Protoscopy, sigmoidoscopy, colonoscopy


  • Establish the cause
  • Increase fibre and fluid diet intake
  • Correct any constipation
  • Sitz bath (sitting for 10-15 minutes in lukewarm water with a spoon of salt) 2 or 3 times a day
  • Insert a bismuth subgallate compound rectally every 12 hours for 5 days (e.g. Anusol, Sediproct
    cream or suppositories)

If signs of infection:

  • Give metronidazole 400 mg every 8 hours for 5 days
  • Give analgesics as required for the pain

If there is no response:

  • Refer to hospital for surgery


  • Maintain high residue (fibre) diet
  • Ensure adequate fluid intake
  • Regular exercise
  • Refrain from straining and reading in the toilet