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
Other diagnostic factors
- intermittent symptoms
- sentinel pile
- fissure visible on retraction of buttock
Risk factors
- hard stool
- pregnancy
- opiate analgesia
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- anal manometry
- anal ultrasound
Treatment algorithm
on presentation
resistant fissures
Contributors
Authors
John R.T. Monson, MD, FRCS (Ire, Eng, Ed [Hon]), FACS, FASCRS
Executive Director
Colorectal Surgery
Florida Hospital System
Florida Hospital Medical Group
Orlando
FL
Disclosures
JRTM declares that he has no competing interests.
Acknowledgements
Dr John Monson would like to gratefully acknowledge Dr John Scholefield and Dr Jonathan Lund, previous contributors to this topic. 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.
Differentials
- Crohn disease
- Sarcoidosis
- Extrapulmonary Tuberculosis
More DifferentialsGuidelines
- Clinical practice guideline for the management of anal fissures
- American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure
More GuidelinesPatient leaflets
Anal tears
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