Anal fissure

Last reviewed: 1 Nov 2022
Last updated: 02 Jul 2020

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
More key diagnostic factors

Other diagnostic factors

  • intermittent symptoms
  • sentinel pile
  • fissure visible on retraction of buttock
Other diagnostic factors

Risk factors

  • hard stool
  • pregnancy
  • opiate analgesia
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • anal manometry
  • anal ultrasound
More investigations to consider

Treatment algorithm

ACUTE

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 Differentials
  • Guidelines

    • Clinical practice guideline for the management of anal fissures
    • American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure
    More Guidelines
  • Patient leaflets

    Anal tears

    More Patient leaflets
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