Direct answer: Piles (bawasir) are swollen cushions inside or outside the anus that bleed and may hang out. A fissure (chira) is a small tear that causes sharp pain during and after potty. A fistula (bhagandar) is a tunnel near the anus that keeps oozing pus. Dr Raman Garg, surgical gastroenterologist in Bathinda, Punjab, India, sorts them out with one examination.
Why people mix them up
All three sit in the same small area, and all three can bleed or hurt. A truck driver from Giddarbaha may say "mujhe bawasir hai" when the real problem is a tear. A farmer from Maur Mandi may ignore a small boil for months, and it turns out to be a fistula. The treatment for each is very different, so the right name matters.
Piles (bawasir, mass): the soft lumps
Piles are veins in the anal canal that become swollen, like varicose veins. Typical signs:
- Bright red blood on the stool paper or dripping after potty, often with little pain
- A soft lump that comes out while passing stool and may go back by itself or need a push
- Itching, a feeling of mucus, or a feeling that the bowel is not fully empty
Constipation, long sitting, heavy lifting and low water intake make piles worse. More on this in our page on piles treatment in Bathinda.
Fissure (kat, chira): the tear
A fissure is a crack in the skin of the anal opening, usually from passing a hard stool. The pain is the clue: sharp, like a blade, during potty, then burning for minutes to hours. You may see a few drops of fresh blood. Many people become afraid of going to the toilet, hold the stool, and the stool becomes harder. That cycle keeps the tear from healing. See fissure treatment in Bathinda.
Fistula (bhagandar): the tunnel
A fistula is a small channel between the inside of the anus and the skin nearby. It often starts as a painful boil (abscess) near the anus. After the boil bursts or is drained, a small opening stays and keeps leaking pus or blood-stained fluid. Signs are repeated boils at the same spot, discharge that stains underwear, and pain on sitting. Medicines alone do not close a fistula, so a surgeon needs to map it. See fistula treatment in Bathinda.
Quick comparison table
| Sign | Piles | Fissure | Fistula |
|---|---|---|---|
| Main complaint | Bleeding, lump | Sharp pain with potty | Pus or fluid discharge |
| Pain | Often little, unless clotted | Strong, burning | Throbbing when infected |
| Blood | Bright red, can drip | Few drops, on paper | Mild, mixed with discharge |
| Lump | Soft, may come out | Small skin tag sometimes | Boil or small opening |
| Heals alone? | Early grade often settles with care | Early tears often heal with care | Rarely |
How Dr Raman Garg checks you
The first step is a short, private examination and a few questions: how long, what colour, any pain, any boils. If needed, a small scope test of the anal canal is done. If you are over 40, or the bleeding is mixed with stool or comes with weight loss, a colonoscopy may be advised to rule out a growth, because not all blood from the back passage is piles. Read blood in stool: causes and when to worry.
Treatment in short
- Piles: fibre, water, and medicines for early grades. Surgery (stapler, ligation or open, as suited) for larger or recurring piles.
- Fissure: stool softeners, warm water sitz bath and ointment first. If it stays for more than 6 to 8 weeks, a small operation (lateral sphincterotomy) helps most patients.
- Fistula: needs a procedure. The plan depends on how close the tunnel is to the muscle that controls stool.
Cost at BGCI, Bathinda
| Item | Starting (Rs) | Average (Rs) | Maximum (Rs) |
|---|---|---|---|
| OPD consultation | 500 | 700 | 1,000 |
| Piles surgery | 35,000 | 55,000 | 85,000 |
| Anal fissure surgery | 28,000 | 40,000 | 65,000 |
| Fistula surgery | 35,000 | 55,000 | 85,000 |
Note: These are typical Punjab costs for 2026. The final cost may vary after Dr Raman Garg examines you, depending on the grade or size of the problem, the type of procedure chosen, anaesthesia type and your health.
Cashless insurance
Many patients need not pay upfront. Bombay Gastro & Cancer Institute is empanelled with Aditya Birla Health Insurance, Niva Bupa, Care Health Insurance, ICICI Lombard, Medi Assist TPA and almost all other major insurers and TPAs. Our insurance desk arranges pre-authorisation. See cashless insurance for gastro treatment.
When to see a doctor (box)
See a doctor within a few days if bleeding repeats, pain stops you from sitting, or a boil keeps returning. Go to hospital the same day for heavy bleeding, fever with a swollen painful area near the anus, dizziness, or a lump that is stuck and very painful. Call +91 82641-60001 any time.
Patients from your area
People travel for this from Goniana Mandi (12 km, 20 min) and Rampura Phul (30 km, 40 min), and from across the Malwa belt. Start with the Bathinda gastro treatment hub, or meet Dr Raman Garg. Related reading: piles ka ilaj: operation ya bina operation. This page is general information; your plan is set after Dr Raman Garg examines you.
Medically reviewed by Dr Raman Garg. Last updated: 8 November 2026.