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Anal fissure

Last reviewed: 13 Oct 2024
Last updated: 22 Dec 2023

Summary

Definition

History and exam

Key diagnostic factors

  • pain on defecation
  • tearing sensation on passing stool
  • fresh blood on stool or on paper
  • anal spasm
Full details

Other diagnostic factors

  • intermittent symptoms
  • sentinel pile
  • fissure visible on retraction of buttock
Full details

Risk factors

  • hard stool
  • pregnancy
  • opiate analgesia
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • anal manometry
  • anal ultrasound
Full details

Treatment algorithm

ACUTE

on presentation

resistant fissures

Contributors

Authors

Nivedh Paluvoi, MD

Assistant Professor of Surgery

Colorectal Surgery

Miller School of Medicine

University of Miami

Coral Gables

FL

Disclosures

NP declares that he has no competing interests.

Acknowledgements

Dr Nivedh Paluvoi would like to gratefully acknowledge Dr John R. T. Monson, Dr John Scholefield, and Dr Jonathan Lund, previous contributors to this topic. JRTM declares that he has no competing interests. JS and JL are authors of a number of references cited in this topic.

Peer reviewers

Stephen H. Leveson, MD, FRCS

Professor

York Hospital

York

UK

Disclosures

SHL declares that he has no competing interests.

Steven Brown, MD, FRCS

Consultant Colorectal Surgeon

Northern General Hospital

Sheffield

UK

Disclosures

SB declares that he has no competing interests.

Jan Rakinic, MD, FACS, FASCRS

Associate Professor of Surgery

Chief

Section of Colorectal Surgery

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JR is an author of a reference cited in this topic.

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