Fast Five Quiz: Anal Fissures and Fistulas

Richard H. Sinert, DO


September 15, 2022

Typically, the symptoms of an anal fissure are relatively specific, and the diagnosis can often be made on the basis of the history alone. However, like other common benign anal pathologic conditions, anal fissure is sometimes misdiagnosed or mistaken for another condition of this type.

Anal fissures may present with rectal pain described as burning, cutting, or tearing that occurs with bowel movements. Spasm of the anus is very suggestive for an anal fissure. A history of constipation or passage of hard stools may be present. Typically, bright-red blood appears on the surface of stools, but blood usually is not mixed into stool and is present only in a small amount. On occasion, blood is found on toilet paper after wiping. The patient may report no bleeding.

Patients with anal fistulas may also describe pain with defecation. They also often experience malodorous perianal drainage, pruritus, recurrent abscesses, fever, or perianal pain due to an occluded tract. Pain occurs with sitting, moving, defecating, and even coughing. It usually is throbbing in quality and is constant throughout the day. Pain occasionally resolves spontaneously with reopening of a tract or formation of a new outflow tract. Patients with anal fistulas may also report a recent perianal or buttock abscess.

Learn more about anal fissures.


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