Anal fissure: Difference between revisions

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==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-->


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[[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-->


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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-->


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*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-->


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*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-->


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*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-->


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*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]
*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]




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


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*[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-->


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<references/>
<references/>




<!--T:23-->
[[Category:GI]]
[[Category:GI]]
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Latest revision as of 20:29, 6 January 2026

Other languages:

Background

Anatomy of the anus.
Anatomy of anal fissure.
  • 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
  • Most common cause of painful rectal bleeding
  • 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)


Clinical Findings

Close up photo of anal fissure (at red arrow).
  • Acute sharp, cutting pain most severe during and immediately after bowel movement
    • Subsides between bowel movements (distinguishes fissure from other anorectal disease)
  • 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


Differential Diagnosis

Anorectal Disorders

Non-GI Look-a-Likes

Undifferentiated lower gastrointestinal bleeding


Evaluation

Workup

  • Typically clinical (no studies needed)


Diagnosis

  • Having patient bear down may make fissure more noticable
  • Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity


Management

  • 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
  • Topicals
  • High-fiber diet
    • Prevents stricture formation by providing a bulky stool
  • 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


Complications


Disposition

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


See Also


External Links


References

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