Most anal fissures are accompanied by sentinel hemorrhoids, especially in patients whose fissure condition has been neglected for a long time, and when it develops into an old anal fissure, it is often accompanied by both external and internal hemorrhoids, when both have basically the same appearance outside the anus. Therefore, it is beneficial to understand the difference between anal fissure and hemorrhoids and to raise awareness of anal abnormalities for treatment. The difference between anal fissures and hemorrhoids from a pathological point of view Anal fissures are mainly manifested by fissures in the skin of the anal canal and ulcers in the anal canal that are difficult to heal. Hemorrhoids, on the other hand, are formed due to the formation of varicose veins and venous masses in the veins around the anus, as well as the sliding of the mucous membrane in the lower rectum. 2. The difference between anal fissure and hemorrhoid from the symptoms (1) Anal fissure is mainly pain and blood in stool. Hemorrhoids are mainly bleeding, and only when the external hemorrhoid is inflamed and swollen, the hemorrhoid will be in severe pain. (2) Anal fissures are visible as fissures in the skin of the anal canal, while hemorrhoids are not. This can be determined during anal fingering, but anal fissures are mostly not feasible for anal fingering, or speculum examination. (3) Most anal fissures are associated with anal papillomata and papillomas, whereas hemorrhoids are not associated with anal papillomata or papillomas. (4) In anal fissures, narrowing of the anal canal is seen in appearance, whereas in hemorrhoids, internal hemorrhoids are more often seen to be prolapsed and ectopic. 3, anal pruritus and hemorrhoids Some patients with hemorrhoids have sticky discharge that causes anal dampness and itching, but anal itching does not necessarily mean hemorrhoids. Anal pruritus is a common localized pruritus. Sometimes there is a slight itching in the anal region, but if the itching is severe and persists for a long time, it becomes pruritus. It is a common confined neurological dermatosis. It is usually limited to the perianal area, and some may spread to the perineum, vulva or the back of the scrotum. It occurs mostly in the middle of the day and in the elderly between the ages of 20 and 40. Initially, anal itching is mild, with no obvious changes in the anal skin, mostly paroxysmal. In patients with prolonged disease, itching is more intense and lasts longer, especially at night. Excessive scratching or mechanical stimulation makes the perianal skin hypertrophy and roughness, deepens the anal folds, local scratches, blood scabs, ooze, and residual fecal dirt in the folds, and in more severe cases, infection can be combined with pus vesicles or purulent secretions, flushing and swelling. Laboratory tests reveal diabetes mellitus, pinworm disease, and Candida albicans infection. Clinical examination of anal pruritus may reveal concurrent internal, external, mixed hemorrhoids, and anal fistula. Therefore, treatment should be given for different conditions.