Hemorrhoids and anal fissures are common clinical conditions, but their symptoms are completely different. Generally, they both share a common symptom, which is the presence of rectal bleeding, and this bleeding is usually bright red blood. The difference between anal fissures and hemorrhoids is that anal fissures primarily cause pain, while hemorrhoids primarily cause bleeding. Hemorrhoids only cause severe pain when external hemorrhoids become inflamed and swollen, while anal fissures often involve enlargement of the anal papillae. Hemorrhoids do not involve enlargement of the anal papillae, and while anal fissures can involve skin tears around the anal canal, hemorrhoids do not. During a digital rectal exam, this can be diagnosed; hemorrhoids are caused by poor local venous circulation, leading to venous congestion and the formation of vascular bulges. Depending on their location, they are divided into internal and external hemorrhoids. Anal fissures are skin tears located on the more lateral parts of the anus, and during defecation, the tear worsens, bleeding and causing severe pain, whereas hemorrhoids usually do not cause severe pain.