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: LeeMS, 55-64 Male (Patient) Published: April 25

It was about six months ago and I was working on a very stressful project. One morning I was using the bathroom and felt something tear when straining, which I had been doing for some time. That was it and I haven"t been the same since. I"ve always had an issue with hemorrhoids, mainly temporary ones, so I figured it was related to that. I decided to see my primary care physician when the pain wouldn"t subside and they gave me Proctofoam, which seemed to help a little. After a couple of weeks, I contacted my doctor who referred me to a specialist. They then informed me of the tear and told me the Proctofoam was "a band aid" and prescribed C-nifedipine, which I have been using ever since. The results are minimal, but helps me to cope. I also take a softener at night and some prune juice at bedtime. I"ve been back to the specialist and although they noticed some slight healing, they suggested surgery or at least Botox injections. I"m not fond of either option. I"ve tried the Dr. Wheatgrass treatment and also raw aloe vera, but they were basically irritants. The Sitz baths only brought relief when I was in them and not afterward, so I quit that process. When I use the bathroom, I put petroleum jelly on the paper and then cleanse the area, usually applying the nifedipine afterward. I am at a point where I can manage, but it isn"t easy. I may try the Jason"s ointment and the Polysporin to see what effect it has. I don"t think the C-nifedipine is the answer and Einstein famously said that to do the same thing over and over and expect different results is a sign of insanity. Good luck to all of you and I"ll let you know if I find something that really works.

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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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