Anal Fissure - Diagnosis

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How are anal fissures diagnosed and evaluated?

A careful history usually suggests that an anal fissure is present, and gentle inspection of the anus can confirm the presence of a fissure. If gentle eversion (pulling apart) the edges of the anus by separating the buttocks does not reveal a fissure, a more vigorous examination following the application of a topical anesthetic to the anus and anal canal may be necessary. A cotton-tipped swab may be inserted into the anus to gently localize the source of the pain.

An acute anal fissure looks like a linear tear. A chronic anal fissure frequently is associated with a triad of findings that includes a tag of skin at the edge of the anus (sentinel pile), thickened edges of the fissure with muscle fibers of the internal sphincter visible at the base of the fissure, and an enlarged anal papilla at the upper end of the fissure in the anal canal.

If rectal bleeding is present, an endoscopic evaluation using a rigid or flexible viewing tube is necessary to exclude the possibility of a more serious disease of the anus and rectum. A sigmoidoscopy that examines only the distal part of the colon may be reasonable in patients younger than 50 years of age who have a typical anal fissure. In patients with a family history of colon cancer or age greater than 50 (and, therefore, at higher risk for colon cancer), a colonoscopy that examines the entire colon is recommended. Atypical fissures that suggest the presence of other diseases, as discussed previously, require other diagnostic studies including colonoscopy and upper gastrointestinal (UGI) and small intestinal X-rays.

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Comment from: leo, 45-54 Female (Patient) Published: August 12

I was diagnosed with grade III hemorrhoid at the result of my colonoscopy last August 2013. Now and then I still bleed after my bowel movement and sometimes when I walk long distance or have been standing for too long I bleed; it bothered me so much. My medications are Faktu cream and Hemorid.

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Comment from: Marla, 55-64 Male (Patient) Published: January 26

In 1973 I weighed 320 lb. and was considered a patient for an intestinal bypass, an experimental form of weight loss surgery. My blood pressure was 240/140 and I was pre-diabetic. I currently (43 years later) weigh 180 and my blood pressure is normal and I am not diabetic. This procedure is no longer used because of many problems like 43 years of diarrhea, insufficient absorption of nutrients, and severe cramping from gas in the stomach and tract. But, I am alive and have lived a full professional life and am living a busy retirement life.

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