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 tests
1st tests to order
- clinical diagnosis
Tests to consider
- anal manometry
- anal ultrasound
Treatment algorithm
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.
Differentials
- Crohn disease
- Sarcoidosis
- Extrapulmonary Tuberculosis
More DifferentialsGuidelines
- Clinical practice guideline for the management of anal fissures
- Consensus guidelines in emergency colorectal surgery
More GuidelinesPatient information
Anal tears
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