Anal fissure - Revision history

Ostermayer: Marked this version for translation

2026-01-06T20:29:22Z

Marked this version for translation

← Older revision		Revision as of 20:29, 6 January 2026
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	<translate>		<translate>

	==Background==		==Background== <!--T:1-->

			<!--T:2-->
	[[File:Human anus-en.png\|thumb\|Anatomy of the anus.]]		[[File:Human anus-en.png\|thumb\|Anatomy of the anus.]]
	[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]		[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]
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	==Clinical Findings==		==Clinical Findings== <!--T:3-->

			<!--T:4-->
	[[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]		[[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]
	*Acute sharp, cutting pain most severe during and immediately after bowel movement		*Acute sharp, cutting pain most severe during and immediately after bowel movement
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	==Differential Diagnosis==		==Differential Diagnosis== <!--T:5-->

	</translate>		</translate>
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	==Evaluation==		==Evaluation== <!--T:6-->


	===Workup===		===Workup=== <!--T:7-->

			<!--T:8-->
	*Typically clinical (no studies needed)		*Typically clinical (no studies needed)


	===Diagnosis===		===Diagnosis=== <!--T:9-->

			<!--T:10-->
	*Having patient bear down may make fissure more noticable		*Having patient bear down may make fissure more noticable
	*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity		*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity
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	==Management==		==Management== <!--T:11-->

			<!--T:12-->
	*Warm sitz baths 15 min TID-QID and after each bowel movement		*Warm sitz baths 15 min TID-QID and after each bowel movement
	**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm		**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm
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	==Complications==		==Complications== <!--T:13-->

			<!--T:14-->
	*[[Special:MyLanguage/Anorectal abscess\|Anorectal abscess]]		*[[Special:MyLanguage/Anorectal abscess\|Anorectal abscess]]


	==Disposition==		==Disposition== <!--T:15-->

			<!--T:16-->
	*Most patients can be managed medically and discharged with outpatient follow-up		*Most patients can be managed medically and discharged with outpatient follow-up


	==See Also==		==See Also== <!--T:17-->

			<!--T:18-->
	*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]		*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]


	==External Links==		==External Links== <!--T:19-->

			<!--T:20-->
	*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]		*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]
	*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED]		*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED]


	==References==		==References== <!--T:21-->

			<!--T:22-->
	<references/>		<references/>


			<!--T:23-->
	[[Category:GI]]		[[Category:GI]]
	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:38:54Z

Prepared the page for translation

← Older revision		Revision as of 21:38, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Human anus-en.png\|thumb\|Anatomy of the anus.]]		[[File:Human anus-en.png\|thumb\|Anatomy of the anus.]]
	[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]		[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]
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	*In >90% of cases anal fissures occur in the midline posteriorly		*In >90% of cases anal fissures occur in the midline posteriorly
	**Non-healing fissure or one not located in midline suggests alternative diagnosis (e.g. Crohn's, malignancy)		**Non-healing fissure or one not located in midline suggests alternative diagnosis (e.g. Crohn's, malignancy)


	==Clinical Findings==		==Clinical Findings==

	[[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]		[[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]
	*Acute sharp, cutting pain most severe during and immediately after bowel movement		*Acute sharp, cutting pain most severe during and immediately after bowel movement
	**Subsides between bowel movements (distinguishes fissure from other anorectal disease)		**Subsides between bowel movements (distinguishes fissure from other anorectal disease)
	*Bright red [[rectal bleeding]], small in quantity (usually noticed only on toilet paper)		*Bright red [[Special:MyLanguage/rectal bleeding\|rectal bleeding]], small in quantity (usually noticed only on toilet paper)
	*Lateral to anus often indicates associated systemic illness such as [[Crohn's]], [[HIV]], [[leukemia]], [[TB]], [[syphilis]]		*Lateral to anus often indicates associated systemic illness such as [[Special:MyLanguage/Crohn's\|Crohn's]], [[Special:MyLanguage/HIV\|HIV]], [[Special:MyLanguage/leukemia\|leukemia]], [[Special:MyLanguage/TB\|TB]], [[Special:MyLanguage/syphilis\|syphilis]]


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Anorectal DDX}}		{{Anorectal DDX}}
			<translate>
			</translate>
	{{Lower GI bleeding DDX}}		{{Lower GI bleeding DDX}}
			<translate>


	==Evaluation==		==Evaluation==


	===Workup===		===Workup===

	*Typically clinical (no studies needed)		*Typically clinical (no studies needed)


	===Diagnosis===		===Diagnosis===

	*Having patient bear down may make fissure more noticable		*Having patient bear down may make fissure more noticable
	*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity		*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity
	**Often misdiagnosed as an external [[hemorrhoid]]		**Often misdiagnosed as an external [[Special:MyLanguage/hemorrhoid\|hemorrhoid]]


	==Management==		==Management==

	*Warm sitz baths 15 min TID-QID and after each bowel movement		*Warm sitz baths 15 min TID-QID and after each bowel movement
	**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm		**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm
	*Topicals		*Topicals
	**Pain control with [[lidocaine]]		**Pain control with [[Special:MyLanguage/lidocaine\|lidocaine]]
	**Vasodilators such as [[nitroglycerin]] or [[nifedipine]] ointment		**Vasodilators such as [[Special:MyLanguage/nitroglycerin\|nitroglycerin]] or [[Special:MyLanguage/nifedipine\|nifedipine]] ointment
	**[[Hydrocortisone]]		**[[Special:MyLanguage/Hydrocortisone\|Hydrocortisone]]
	*High-fiber diet		*High-fiber diet
	**Prevents stricture formation by providing a bulky stool		**Prevents stricture formation by providing a bulky stool
	*Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly		*Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly
	*Surgical referral indicated if healing does not occur in a reasonable amount of time		*Surgical referral indicated if healing does not occur in a reasonable amount of time


	==Complications==		==Complications==
	*[[Anorectal abscess]]
			*[[Special:MyLanguage/Anorectal abscess\|Anorectal abscess]]


	==Disposition==		==Disposition==

	*Most patients can be managed medically and discharged with outpatient follow-up		*Most patients can be managed medically and discharged with outpatient follow-up


	==See Also==		==See Also==
	*[[Anorectal Disorders]]
			*[[Special:MyLanguage/Anorectal Disorders\|Anorectal Disorders]]


	==External Links==		==External Links==

	*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]		*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]
	*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED]		*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED]


	==References==		==References==

	<references/>		<references/>


	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1: /* Background */

2024-02-08T00:44:13Z

Background

← Older revision		Revision as of 00:44, 8 February 2024
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Human anus-en.png\|thumb\|Anatomy of the anus.]]
	[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]		[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]
	*Superficial linear tear of anal canal from at/below dentate line to anal verge		*Superficial linear tear of anal canal from at/below dentate line to anal verge

Rossdonaldson1: /* Background */

2024-02-08T00:39:05Z

Background

← Older revision		Revision as of 00:39, 8 February 2024
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Gynecological diagnosis (1910) (14798113703).jpg\|thumb\|Anatomy of anal fissure.]]
	*Superficial linear tear of anal canal from at/below dentate line to anal verge		*Superficial linear tear of anal canal from at/below dentate line to anal verge
	**May be due to passage of hard stool, frequent diarrhea, or abuse		**May be due to passage of hard stool, frequent diarrhea, or abuse

Rossdonaldson1: /* Clinical Findings */

2024-02-08T00:32:22Z

Clinical Findings

← Older revision		Revision as of 00:32, 8 February 2024
Line 7:		Line 7:

	==Clinical Findings==		==Clinical Findings==
	[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]		[[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]
	*Acute sharp, cutting pain most severe during and immediately after bowel movement		*Acute sharp, cutting pain most severe during and immediately after bowel movement
	**Subsides between bowel movements (distinguishes fissure from other anorectal disease)		**Subsides between bowel movements (distinguishes fissure from other anorectal disease)

Rossdonaldson1 at 00:32, 8 February 2024

2024-02-08T00:32:07Z

← Older revision		Revision as of 00:32, 8 February 2024
Line 7:		Line 7:

	==Clinical Findings==		==Clinical Findings==
			[File:Anal fissure 2.jpg\|thumb\|Close up photo of anal fissure (at red arrow).]]
	*Acute sharp, cutting pain most severe during and immediately after bowel movement		*Acute sharp, cutting pain most severe during and immediately after bowel movement
	**Subsides between bowel movements (distinguishes fissure from other anorectal disease)		**Subsides between bowel movements (distinguishes fissure from other anorectal disease)
	*Bright red [[rectal bleeding]], small in quantity (usually noticed only on toilet paper)		*Bright red [[rectal bleeding]], small in quantity (usually noticed only on toilet paper)
	*Lateral to anus often indicates associated systemic illness such as [[Crohn's]], [[HIV]], [[leukemia]], [[TB]], [[syphilis]]		*Lateral to anus often indicates associated systemic illness such as [[Crohn's]], [[HIV]], [[leukemia]], [[TB]], [[syphilis]]

			==Differential Diagnosis==
			{{Anorectal DDX}}
			{{Lower GI bleeding DDX}}

	==Evaluation==		==Evaluation==
			===Workup===
			*Typically clinical (no studies needed)

			===Diagnosis===
	*Having patient bear down may make fissure more noticable		*Having patient bear down may make fissure more noticable
	*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity		*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity
	**Often misdiagnosed as an external [[hemorrhoid]]		**Often misdiagnosed as an external [[hemorrhoid]]

	~~==Differential Diagnosis==~~
	~~{{Anorectal DDX}}~~
	~~{{Lower GI bleeding DDX}}~~

	==Management==		==Management==

Blsimpso at 01:40, 17 August 2021

2021-08-17T01:40:01Z

← Older revision		Revision as of 01:40, 17 August 2021
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	==See Also==		==See Also==
	*[[Anorectal Disorders]]		*[[Anorectal Disorders]]

			==External Links==
			*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]
			*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED]

	==References==		==References==

Blsimpso at 01:36, 17 August 2021

2021-08-17T01:36:52Z

← Older revision		Revision as of 01:36, 17 August 2021
Line 35:		Line 35:
	==Complications==		==Complications==
	*[[Anorectal abscess]]		*[[Anorectal abscess]]

			==Disposition==
			*Most patients can be managed medically and discharged with outpatient follow-up

	==See Also==		==See Also==

ClaireLewis: /* Complications */

2019-09-29T18:59:00Z

Complications

← Older revision		Revision as of 18:59, 29 September 2019
Line 34:		Line 34:

	==Complications==		==Complications==
	[[Anorectal abscess]]		*[[Anorectal abscess]]

	==See Also==		==See Also==

ClaireLewis at 18:58, 29 September 2019

2019-09-29T18:58:39Z

← Older revision		Revision as of 18:58, 29 September 2019
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	*Most common cause of painful rectal bleeding		*Most common cause of painful rectal bleeding
	*In >90% of cases anal fissures occur in the midline posteriorly		*In >90% of cases anal fissures occur in the midline posteriorly
	**~~Nonhealing~~ fissure or one not located in midline suggests alternative diagnosis (e.g. ~~Chrons~~, malignancy)		**Non-healing fissure or one not located in midline suggests alternative diagnosis (e.g. Crohn's, malignancy)

	==Clinical Findings==		==Clinical Findings==
	*Acute sharp, cutting pain most severe during and immediately after bowel movement		*Acute sharp, cutting pain most severe during and immediately after bowel movement
	**Subsides between bowel movements (distinguishes fissure from other anorectal disease)		**Subsides between bowel movements (distinguishes fissure from other anorectal disease)
	*Bright red bleeding, small in quantity (usually noticed only on toilet paper)		*Bright red [[rectal bleeding]], small in quantity (usually noticed only on toilet paper)
	*Lateral to anus often indicates associated systemic illness such as ~~Crohns~~, HIV, ~~Leukemia~~, TB, ~~syphillis~~		*Lateral to anus often indicates associated systemic illness such as [[Crohn's]], [[HIV]], [[leukemia]], [[TB]], [[syphilis]]

	==Evaluation==		==Evaluation==
	*Having patient bear down may make fissure more noticable		*Having patient bear down may make fissure more noticable
	*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity		*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity
	**Often misdiagnosed as an external hemorrhoid		**Often misdiagnosed as an external [[hemorrhoid]]

	==Differential Diagnosis==		==Differential Diagnosis==
Line 25:		Line 25:
	**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm		**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm
	*Topicals		*Topicals
	**Pain control with lidocaine		**Pain control with [[lidocaine]]
	**Vasodilators such as nitroglycerin or nifedipine ointment		**Vasodilators such as [[nitroglycerin]] or [[nifedipine]] ointment
	**~~Hydrocortizone~~		**[[Hydrocortisone]]
	*High-fiber diet		*High-fiber diet
	**Prevents stricture formation by providing a bulky stool		**Prevents stricture formation by providing a bulky stool