Fast Five Quiz: Anal Conditions

Richard H. Sinert, DO


March 26, 2021

An anal fissure is a painful linear tear or crack in the distal anal canal. In the short term, anal fissures usually involve only the epithelium; in the long term, they involve the full thickness of the anal mucosa. Anal fissures develop with equal frequency in both sexes; they tend to occur in younger and middle-aged persons.

Most anal fissures occur in the posterior midline, with the remainder occurring in the anterior midline. Typically, the patient reports severe pain during a bowel movement, with the pain lasting several minutes to hours afterward. The pain recurs with every bowel movement, and the patient commonly becomes afraid or unwilling to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Occasionally, a few drops of blood may fall in the toilet bowl, but significant bleeding does not usually occur with an anal fissure.

The diagnosis of anal fissure can usually be made on the basis of findings from a gentle perianal examination with inspection of the anal mucosa, in conjunction with a good history. In this case, no diagnostic procedures are required. A digital rectal examination is painful and often can be deferred.

According to guidelines from the American Society of Colon and Rectal Surgeons, nonoperative treatment should typically be the first-line treatment for patients with acute anal fissures. This consists of sitz baths and the use of bulking agents, with or without the addition of topical anesthetics or topical steroids.

Read more about anal fissures.


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