Materiały źródłowe

• #1 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  An anal fissure is a superficial tear in the skin distal to the dentate line. […] The diagnosis of an anal fissure is primarily clinical. Several treatment options exist, including medical management and surgical options. […] Evaluation of both acute and chronic anal fissures initially involves determining if it is a primary or secondary anal fissure. […] An anal fissure is a clinical diagnosis made essentially by physical exam alone, which must be done to rule out other possible causes of rectal pain. […] Acute anal fissures in low-risk patients typically do well with conservative management and resolve within a few days to a few weeks. However, some of these patients develop CAF, which requires pharmacological treatment or surgical management. […] The complications of anal fissures include bleeding, pain, infection, incontinence, and fistula formation, which is the most serious complication of anal fissures.

• #2 Anal fissure: Clinical manifestations, diagnosis, prevention – UpToDate

  https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention

  Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding. […] The pathogenesis, clinical manifestations, diagnosis, and prevention of primary sporadic anal fissure are discussed in this topic, while the medical and surgical treatment is presented in other topics. […] Anal fissures most often affect infants and middle-age individuals. […] It is estimated that approximately 235,000 new cases of anal fissure occur every year in the United States. […] However, a more precise incidence cannot be established, because anal discomfort is often misattributed to symptomatic hemorrhoids. […] Anal fissures typically start with a tear to the anoderm within the distal half of the anal canal. […] The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients. […] The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

• #3 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #4

  https://www.nhs.uk/conditions/anal-fissure/

  See a GP if you think you have an anal fissure. […] Most anal fissures get better without treatment, but a GP will want to rule out other conditions with similar symptoms, such as piles (haemorrhoids). […] The GP will ask you about your symptoms and the type of pain you have been experiencing. […] They’ll usually be able to see the fissure by gently parting your buttocks. […] A digital rectal examination, where a GP inserts a lubricated, gloved finger into your bottom to feel for abnormalities, is not usually used to diagnose anal fissures as it’s likely to be painful. […] The GP may refer you for specialist assessment if they think something serious may be causing your fissure. […] Occasionally, a measurement of anal sphincter pressure may be taken for fissures that have not responded to simple treatments.

• #5 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  Anal fissure: diagnosis with us […] For us, the diagnosis anal fissure is usually easy to make and not a problem. Even the discussion of the medical history the anamnesis provides the first clues. For example, the following questions are important: […] What exactly are your symptoms? (e.g. pain during and after defecation). […] How long have you had the symptoms and how intense are they? […] Do you have any known diseases, for example chronic inflammatory bowel disease? […] Are you taking any medications? If yes: Which ones and since when? […] This is usually followed by further examinations to diagnose the anal fissure. […] Further examinations […] Physical examination: During the physical examination, we carefully palpate the mucosa of the rectum with our finger to detect any changes.

• #6 Anal fissure – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/563

  Anal fissure causes severe pain on defecation, often described as 'like passing broken glass’. The pain may continue for 1 to 2 hours and can also be burning in nature. […] On examination of the anus, there is often marked spasm of the sphincter muscles, with significant tenderness often precluding digital examination. […] Key diagnostic factors include presence of risk factors, pain on defecation, tearing sensation on passing stool, fresh blood on stool or on paper, and anal spasm. […] 1st investigations to order include clinical diagnosis. […] Investigations to consider include anal manometry and anal ultrasound.

• #7 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #8

  https://www.nhs.uk/conditions/anal-fissure/

  See a GP if you think you have an anal fissure. […] Most anal fissures get better without treatment, but a GP will want to rule out other conditions with similar symptoms, such as piles (haemorrhoids). […] The GP will ask you about your symptoms and the type of pain you have been experiencing. […] They’ll usually be able to see the fissure by gently parting your buttocks. […] A digital rectal examination, where a GP inserts a lubricated, gloved finger into your bottom to feel for abnormalities, is not usually used to diagnose anal fissures as it’s likely to be painful. […] The GP may refer you for specialist assessment if they think something serious may be causing your fissure. […] Occasionally, a measurement of anal sphincter pressure may be taken for fissures that have not responded to simple treatments.

• #9 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  A common finding on examination is spasm of the anal canal due to hypertonia of the anal sphincter. Digital rectal exam is not recommended in primary care due to the associated pain. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. For these patients, management of the underlying condition should also be optimised and referral initiated. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed. If an anal fissure is suspected to be secondary to a serious underlying condition, referral should be expedited.

• #10 Anal Fissure Workup: Laboratory Studies, Procedures, Histologic Findings

  https://emedicine.medscape.com/article/196297-workup

  If an ordinary anal fissure is suggested and if it is located in the posterior or anterior midline, then no laboratory tests are necessary. […] If the fissure is off the midline or irregular, or if an underlying illness (eg, Crohn disease, squamous cell cancer, or AIDS) may be present, then the appropriate tests should be ordered; these may include the following: Erythrocyte sedimentation rate (ESR), Stool and viral cultures, HIV testing, Biopsy of the lesion or fissure (as warranted). […] The diagnosis of anal fissure can usually be made on the basis of findings from a gentle perianal examination with inspection of the anal mucosa, in conjunction with a good history. In this case, no diagnostic procedures are required. […] Occasionally, the fissure is not easily visualized, and anoscopy is required to see it.

• #11 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics/print

  Anal fissures can usually be diagnosed based on the symptoms described above and a physical examination. […] A fissure most commonly appears in the 12 or 6 o’clock position. Fissures located in other locations are more likely to be associated with an underlying disorder (eg, Crohn disease). […] A rectal examination (insertion of a gloved finger into the anus) or anoscopy (insertion of a small instrument to view the anal canal) can often be avoided in the initial diagnosis of a fissure. […] If the diagnosis is unclear, a sigmoidoscopy or colonoscopy is usually recommended, especially if there has been rectal bleeding.

• #12 Diagnosis and Management of Patients with Anal Fissures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0401/p1608.html

  Patients with anal fissures usually present with pain and bleeding. An accurate diagnosis can often be made on the basis of the patient’s history. The diagnosis is based on the classic symptoms and a split in the epithelium at or within the anal verge, which is visualized best with lateral traction applied to the opposite buttock. […] If the fissure is off midline, evaluation for some other diagnosis, including Crohn’s disease, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and associated infections, ulcerative colitis, tuberculosis, syphilis, leukemia, or cancer, is required. […] The statement and review conclude by noting that conservative therapy is risk-free but may take longer to achieve symptom relief. Sphincterotomy is a more familiar treatment in select cases, but the use of topical therapy and botulin toxin injection are gaining support, even in patients who are less symptomatic.

• #13 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  A common finding on examination is spasm of the anal canal due to hypertonia of the anal sphincter. Digital rectal exam is not recommended in primary care due to the associated pain. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. For these patients, management of the underlying condition should also be optimised and referral initiated. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed. If an anal fissure is suspected to be secondary to a serious underlying condition, referral should be expedited.

• #14 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  A doctor may diagnose anal fissure based on a description of the symptoms and a physical examination. […] The physical examination usually involves gently separating the buttocks to allow a doctor to see the area around the anus. […] Most fissures appear in the 12 or 6 o’clock position. Those in other locations are likely to be associated with an underlying disorder, such as Crohn’s disease. […] A doctor will usually avoid inserting anything into the anal canal, such as a gloved finger or small instrument, as this can cause substantial pain and is often unnecessary for provisional diagnosis. […] If there is recurring or chronic anal fissure, endoscopy procedures to look inside the body may be recommended to look for underlying causes. […] This involves inserting a thin, flexible tube with a light and camera on the end into the anal canal.

• #15 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  Proctoscopy: A reflection of the rectum with an endoscope (proctoscopy) shows whether the anal canal as well as the rectum are intact or damaged. The proctoscope is a thin metal tube that we push into the rectum. Sometimes we perform proctoscopy under regional anesthesia (local anesthesia) or a short anesthesia. This is because the region around the anus and rectum is very sensitive to pain because numerous nerve fibers run there. […] Colonoscopy: Possibly a colonoscopy if abnormalities exist or the anal fissure has not healed even weeks later.

• #16 Anal Fissure Workup: Laboratory Studies, Procedures, Histologic Findings

  https://emedicine.medscape.com/article/196297-workup

  Patients who do not heal, those who have relief from symptoms with appropriate therapy, or those who have a recurrent anal fissure after surgical therapy should be evaluated further with anoscopy and rigid proctosigmoidoscopy to exclude other pathologies. […] Patients with chronic fissures tend to have less pain and can better tolerate either anoscopy or rigid proctosigmoidoscopy and should have this included in their evaluation.

• #17 Anal Fissures – Treatment & Diagnosis | MedStar Health

  https://www.medstarhealth.org/services/anal-fissures

  A provider may diagnose this condition by visual examination on rectal exam. […] Occasionally, an anoscope can be used to visualize how far the fissure extends into the body.

• #18 Understanding anal fissures: Causes, symptoms, diagnosis and treatment options | King Edward VII’s Hospital

  https://www.kingedwardvii.co.uk/health-hub/anal-fissures-causes-symptoms-diagnosis-treatment-options

  Anal fissures are a common condition that affects many people around the world. They are small tears or cuts in the lining of the anus, which can cause significant discomfort and pain. […] If you are experiencing symptoms of anal fissures, it is important to seek medical attention to determine the underlying cause and develop an appropriate treatment plan. […] An anal fissure is typically diagnosed through a physical exam and a review of the patient’s medical history. During the physical exam, a healthcare provider will typically examine the anal area for signs of a fissure, including redness, swelling and the presence of any tears or cuts. They may also perform a digital rectal exam to check for any abnormalities in the rectal area. […] In some cases, additional tests may be necessary to confirm the diagnosis or rule out other conditions. These tests may include: Anoscopy, Sigmoidoscopy, Colonoscopy. […] In some cases, imaging tests such as an MRI or CT scan may also be used to provide a more detailed view of the anal area and surrounding tissues.

• #19 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  Proctoscopy: A reflection of the rectum with an endoscope (proctoscopy) shows whether the anal canal as well as the rectum are intact or damaged. The proctoscope is a thin metal tube that we push into the rectum. Sometimes we perform proctoscopy under regional anesthesia (local anesthesia) or a short anesthesia. This is because the region around the anus and rectum is very sensitive to pain because numerous nerve fibers run there. […] Colonoscopy: Possibly a colonoscopy if abnormalities exist or the anal fissure has not healed even weeks later.

• #20 Diagnosing Anal Fissures: A Comprehensive Guide – Dr. Husain Gheewala – Colorectal Surgeon in Mumbai

  https://drhusaingheewala.com/diagnosing-anal-fissures-a-comprehensive-guide/

  Anal fissures are small tears in the lining of the anus that can cause significant discomfort, pain, and bleeding during bowel movements. […] Proper diagnosis is essential for effective treatment and relief. This article explores the various methods used to diagnose anal fissures and when to seek medical attention. […] Healthcare providers use various techniques to diagnose anal fissures and rule out other potential conditions. Here are the most common diagnostic procedures: […] A physician typically begins with a gentle visual examination of the anal area. In most cases, acute fissures can be identified by their characteristic appearance. […] An anoscopy is a simple procedure in which a small, tube-like instrument called an anoscope is inserted into the anus. This allows the doctor to examine the anal canal more closely and assess the extent of the tear.

• #21 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  A common finding on examination is spasm of the anal canal due to hypertonia of the anal sphincter. Digital rectal exam is not recommended in primary care due to the associated pain. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. For these patients, management of the underlying condition should also be optimised and referral initiated. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed. If an anal fissure is suspected to be secondary to a serious underlying condition, referral should be expedited.

• #22 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  Proctoscopy: A reflection of the rectum with an endoscope (proctoscopy) shows whether the anal canal as well as the rectum are intact or damaged. The proctoscope is a thin metal tube that we push into the rectum. Sometimes we perform proctoscopy under regional anesthesia (local anesthesia) or a short anesthesia. This is because the region around the anus and rectum is very sensitive to pain because numerous nerve fibers run there. […] Colonoscopy: Possibly a colonoscopy if abnormalities exist or the anal fissure has not healed even weeks later.

• #23 Anal Fissure Workup: Laboratory Studies, Procedures, Histologic Findings

  https://emedicine.medscape.com/article/196297-workup

  If an ordinary anal fissure is suggested and if it is located in the posterior or anterior midline, then no laboratory tests are necessary. […] If the fissure is off the midline or irregular, or if an underlying illness (eg, Crohn disease, squamous cell cancer, or AIDS) may be present, then the appropriate tests should be ordered; these may include the following: Erythrocyte sedimentation rate (ESR), Stool and viral cultures, HIV testing, Biopsy of the lesion or fissure (as warranted). […] The diagnosis of anal fissure can usually be made on the basis of findings from a gentle perianal examination with inspection of the anal mucosa, in conjunction with a good history. In this case, no diagnostic procedures are required. […] Occasionally, the fissure is not easily visualized, and anoscopy is required to see it.

• #24 Understanding anal fissures: Causes, symptoms, diagnosis and treatment options | King Edward VII’s Hospital

  https://www.kingedwardvii.co.uk/health-hub/anal-fissures-causes-symptoms-diagnosis-treatment-options

  Anal fissures are a common condition that affects many people around the world. They are small tears or cuts in the lining of the anus, which can cause significant discomfort and pain. […] If you are experiencing symptoms of anal fissures, it is important to seek medical attention to determine the underlying cause and develop an appropriate treatment plan. […] An anal fissure is typically diagnosed through a physical exam and a review of the patient’s medical history. During the physical exam, a healthcare provider will typically examine the anal area for signs of a fissure, including redness, swelling and the presence of any tears or cuts. They may also perform a digital rectal exam to check for any abnormalities in the rectal area. […] In some cases, additional tests may be necessary to confirm the diagnosis or rule out other conditions. These tests may include: Anoscopy, Sigmoidoscopy, Colonoscopy. […] In some cases, imaging tests such as an MRI or CT scan may also be used to provide a more detailed view of the anal area and surrounding tissues.

• #25 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/content/anal-fissure

  Doctor can diagnose anal fissure by taking a detailed patients history and physical examination to rule out other conditions such as hemorrhoids, anal fistula, etc. […] A thorough physical examination can detect the fissure either in the front or the back of the anus. […] Differential diagnosis may be necessary such as endoscopy for tissue biopsies, and other laboratory tests for comorbidities such as syphilis and HIV.

• #26 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Those who have a chronic or recurrent anal fissure after surgical therapy may be evaluated further with anoscopy and sigmoidoscopy, a procedure similar to anoscopy, but which also examines the lower colon. […] Sometimes, a colonoscopy procedure is used to look for the presence of an underlying condition that may be causing an anal fissure, such as irritable bowel syndrome (IBS). […] Anal fissures are sometimes misdiagnosed as hemorrhoids. This can delay appropriate treatment, which may lead to an acute fissure becoming a chronic one, which is more difficult to treat. […] Wrongful diagnosis of anal fissure can also occur because it is more common than some conditions with similar symptoms.

• #27 Anal fissure differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Anal_fissure_differential_diagnosis

  Anal fissure must be differentiated from other diseases that cause anal discomfort and pain with defecation such as hemorrhoids, rectal prolapse and perianal abscess, anal fistula and anal cancer. […] Anal fissure usually presents with tearing pain with every bowel movement. […] About two-thirds of the patients present with bright red blood streaks on toilet papers or on the surface of stools. […] Most fissures occur in the posterior midline of the anal canal. […] Skin tags in the perianal area may accompany chronic anal fissures.

• #28 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #29 Anal fissure: diagnosis, management, and referral in primary care | British Journal of General Practice

  https://bjgp.org/content/69/685/409

  Anal fissures are tears of the anal mucosa. […] Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. […] Digital rectal exam is not recommended in primary care due to the associated pain. […] Glyceryl trinitrate 0.2% or 0.4% rectal ointment can be prescribed to encourage healing of anal fissures. […] When medical therapy has failed, local injection of Botox is recommended. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. […] In all children with ongoing anal fissure for 2 weeks despite treatment. […] In adults with ongoing pain after 8 weeks. […] If a secondary fissure is suspected due to a condition which warrants referral; that is, colorectal cancer or inflammatory bowel disease. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed.

• #30 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  A healthcare professional will likely ask about medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this exam is all that’s needed to diagnose an anal fissure. […] A fissure is considered chronic if it lasts more than eight weeks. […] A medical professional may recommend further testing to find out if there is an underlying condition. Tests may include: […] Colonoscopy may be done for someone who: […] Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.

• #31 Anal Fissure – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/anal-fissure/

  An anal fissure is a tear in the mucosal lining of the anal canal, most commonly due to trauma from defecation of hard stool. It can be classified according to its duration: Acute present for 6 weeks […] Chronic present for 6 weeks. Anal fissures can also be categorised by whether they are primary (no underlying disease) or secondary (underlying disease e.g inflammatory bowel disease). […] The most common presenting feature of an anal fissure is intense pain post-defecation, which can last several hours. Pain can be far out of proportion to the size of the fissure. Other associated symptoms may include bleeding (commonly bright red blood on wiping) or itching, both typically post-defecation. […] On examination, fissures can be visible and/or palpable (albeit very painfully) on digital rectal examination. Most fissures present in the posterior midline (90% cases); anterior fissures are more likely to in females (especially after childbirth) or if an underlying cause is present.

• #32 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  An anal fissure is a superficial tear in the skin distal to the dentate line. […] The diagnosis of an anal fissure is primarily clinical. Several treatment options exist, including medical management and surgical options. […] Evaluation of both acute and chronic anal fissures initially involves determining if it is a primary or secondary anal fissure. […] An anal fissure is a clinical diagnosis made essentially by physical exam alone, which must be done to rule out other possible causes of rectal pain. […] Acute anal fissures in low-risk patients typically do well with conservative management and resolve within a few days to a few weeks. However, some of these patients develop CAF, which requires pharmacological treatment or surgical management. […] The complications of anal fissures include bleeding, pain, infection, incontinence, and fistula formation, which is the most serious complication of anal fissures.

• #33 Anal Fissure

  http://healthlibrary.gradyhealth.org/Wellness/Cholesterol/134,174

  How is an anal fissure diagnosed? Your healthcare provider will ask about your symptoms and health history. Your provider will give you a physical exam. The physical exam will include examining your anal area. […] You may have a digital rectal exam and a fecal occult blood test. […] An acute anal fissure often heals within 6 weeks with simple treatment. […] A chronic anal fissure lasts for 6 weeks or more. This may need more treatment, such as surgery.

• #34 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  How are anal fissures diagnosed? A healthcare provider will ask you about your symptoms, then try to see the fissure. You’ll lie on your belly or on your side while they gently separate your buttocks. If this is too painful, they don’t have to go further. They can safely assume that you have an anal fissure. […] But if you can tolerate an exam, they’ll try to see the fissure so that they can rule out other possible causes for your symptoms. They might gently insert a lubricated gloved finger to open your anus, noticing any tenderness or muscle spasms. This is a digital rectal exam. […] Most anal fissures heal within a few days to weeks. A chronic anal fissure lasts more than eight weeks. If you’re in treatment for a chronic anal fissure, it may take another six to 12 weeks for the treatment to work and the fissure to finally heal. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues.

• #35 Diagnosis of CAF – Grunenthal Meds Hub

  https://www.grunenthalmedshub.co.uk/therapy-areas/gastrointestinal/chronic-anal-fissure/disease-pages/diagnosis

  Diagnosis of chronic anal fissure. Anal fissure can be classified according to how long symptoms last and their cause. Acute fissure: Tend to be present for less than 6 weeks and are superficial, with well-demarcated edges. Chronic fissure: Tend to persist for 6 weeks or more and are wider and deeper with muscle fibres visible in the base. The edges are often swollen, and a skin tag may be visible at the end of the fissure. Acute and chronic anal fissure can present as either primary or secondary. Clinical features of anal fissure include anal pain with defaecation (with or without bright red rectal bleeding) and anal spasm. Chronic anal fissure can occur in all ages but are most common in people aged 15-40 years. Chronic anal fissure can present bleeding on defaecation, usually bright red with a small quantity on stool or toilet paper. Pain on defaecation is a common symptom of chronic anal fissure. The sharp pain associated with anal fissure is due to the fissure opening up when the bowels are opened, and has been described as like passing broken glass. External examination of the anus may reveal a linear split in the anal mucosa. Chronic anal fissure are wide and deep with muscle fibres visible in the base. The edges are often swollen, and a skin tag may be visible at the end of the fissure.

• #36 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  How are anal fissures diagnosed? A healthcare provider will ask you about your symptoms, then try to see the fissure. You’ll lie on your belly or on your side while they gently separate your buttocks. If this is too painful, they don’t have to go further. They can safely assume that you have an anal fissure. […] But if you can tolerate an exam, they’ll try to see the fissure so that they can rule out other possible causes for your symptoms. They might gently insert a lubricated gloved finger to open your anus, noticing any tenderness or muscle spasms. This is a digital rectal exam. […] Most anal fissures heal within a few days to weeks. A chronic anal fissure lasts more than eight weeks. If you’re in treatment for a chronic anal fissure, it may take another six to 12 weeks for the treatment to work and the fissure to finally heal. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues.

• #37 Anal fissures | Providence Health Care

  https://www.providencehealthcare.org/en/health-services/conditions/digestive-gastrointestinal-conditions/anal-fissures

  To diagnose an anal fissure, a health care professional will look at your rectal area. They will look for tears in the rectal lining. […] Anal fissures are acute if they last for a short time. They are chronic if they last for more than eight weeks. […] A chronic anal fissure typically heals within 6 to 12 weeks with medical treatment.

• #38 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  A healthcare professional will likely ask about medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this exam is all that’s needed to diagnose an anal fissure. […] A fissure is considered chronic if it lasts more than eight weeks. […] A medical professional may recommend further testing to find out if there is an underlying condition. Tests may include: […] Colonoscopy may be done for someone who: […] Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.

• #39

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  Anal fissures typically cause a sharp pain that starts with the passage of stool. […] Your physician will discuss the benefits and side effects of treatments. […] Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. […] The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. […] If a fissure does not improve with treatment, it is important to be evaluated for other possible conditions. […] Anal fissures do not increase the risk of colon cancer nor cause it. However, more serious conditions can cause similar symptoms. Even when a fissure has healed completely, your colon and rectal surgeon may request other tests. A colonoscopy may be done to rule out other causes of rectal bleeding.

• #40 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #41 Anal Fissure – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/anal-fissure/

  An anal fissure is a tear in the mucosal lining of the anal canal, most commonly due to trauma from defecation of hard stool. It can be classified according to its duration: Acute present for 6 weeks […] Chronic present for 6 weeks. Anal fissures can also be categorised by whether they are primary (no underlying disease) or secondary (underlying disease e.g inflammatory bowel disease). […] The most common presenting feature of an anal fissure is intense pain post-defecation, which can last several hours. Pain can be far out of proportion to the size of the fissure. Other associated symptoms may include bleeding (commonly bright red blood on wiping) or itching, both typically post-defecation. […] On examination, fissures can be visible and/or palpable (albeit very painfully) on digital rectal examination. Most fissures present in the posterior midline (90% cases); anterior fissures are more likely to in females (especially after childbirth) or if an underlying cause is present.

• #42 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #43 Anal Fissure Clinical Presentation: History, Physical Examination

  https://emedicine.medscape.com/article/196297-clinical

  Initially, the fissure is just a tear in the anal mucosa and is defined as an acute anal fissure. […] If the fissure persists over time, it progresses to a chronic fissure that can be distinguished by its classic features. […] The fibers of the internal anal sphincter are visible in the base of the chronic fissure, and often, an enlarged anal skin tag is present distal to the fissure and hypertrophied anal papillae are present in the anal canal proximal to the fissure. […] Most anal fissures occur in the posterior midline, with the remainder occurring in the anterior midline (99% of men, 90% of women). […] About 2% of patients have anterior and posterior fissures. […] Fissures occurring off the midline should raise the possibility of other bowel conditions (eg, Crohn disease), infection (eg, sexually transmitted disease or AIDS), or cancer.

• #44 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 12 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. […] Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease; HIV/AIDS; colorectal cancer; dermatological conditions such as psoriasis or pruritis ani; anal trauma (anal sex, surgery, pregnancy); and medications, for example, opioids or chemotherapy. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. Most fissures occur in the midline posteriorly. Acute fissures are apparent as a fresh break in the skin immediately inside the anal margin. Chronic fissures are usually accompanied by a skin tag at the distal end of the fissure and exposure of the circular fibres of the internal sphincter (a sentinel tag).

• #45 Anal Fissure Sugar Land, TX | Lateral Internal Sphincterotomy | Fissurectomy Sugar Land, TX

  https://www.gidoc.net/anal-fissure-gastroenterologist-sugar-land-tx/

  Depending on its severity, anal fissures can be acute or chronic. […] Your doctor will review your medical history and conduct a physical examination of the anal region. Most anal fissures can be diagnosed by viewing the anal region on separating the buttocks. If the tear is visible, diagnosis becomes easy and treatment can be started immediately. If not, a sample of the rectal tissue may be removed for examination. […] Anal fissures can be diagnosed by digital rectal examination or using an instrument called an anoscope. The digital rectal examination involves inserting a gloved finger into the anal canal. The anoscope is a short instrument with a lighted tube that can help your doctor view and examine the fissure. […] Your doctor will have to rule out other problems that can cause fissures. Anal fissures are characteristically located either on the back or front surfaces of the anus. If your condition is characterized by several fissures, or the fissures are located on the sides of the anus, then you may be suffering from a different condition (inflammatory bowel disease, anal cancer, syphilis or HIV infection). Your doctor will conduct further tests to confirm these conditions.

• #46 Diagnosis and Management of Patients with Anal Fissures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0401/p1608.html

  Patients with anal fissures usually present with pain and bleeding. An accurate diagnosis can often be made on the basis of the patient’s history. The diagnosis is based on the classic symptoms and a split in the epithelium at or within the anal verge, which is visualized best with lateral traction applied to the opposite buttock. […] If the fissure is off midline, evaluation for some other diagnosis, including Crohn’s disease, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and associated infections, ulcerative colitis, tuberculosis, syphilis, leukemia, or cancer, is required. […] The statement and review conclude by noting that conservative therapy is risk-free but may take longer to achieve symptom relief. Sphincterotomy is a more familiar treatment in select cases, but the use of topical therapy and botulin toxin injection are gaining support, even in patients who are less symptomatic.

• #47 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  An anal fissure is a small cut or tear in the lining of the anus. […] If an anal fissure doesn’t improve with these treatments, you may need surgery. Or your doctor may need to look for other underlying disorders that can cause anal fissures. […] A calcium channel blocker ointment can relax the sphincter muscles and allow the anal fissure to heal. […] If your anal fissure fails to respond to other treatments, your doctor may recommend an anal sphincterotomy. […] This surgical procedure involves making a small incision in the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal. […] However, this procedure comes with a small risk of permanent incontinence, meaning you may no longer be able to control when you pass stool. […] Sustained or repeated trauma to the area is the most frequent cause of anal fissures. Childbirth, anal sex, and the passing of hard stools are all common reasons for anal fissures. […] Other conditions associated with anal fissures include previous anal surgeries, inflammatory bowel disease, local cancers, and sexually transmitted infections.

• #48 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  A common finding on examination is spasm of the anal canal due to hypertonia of the anal sphincter. Digital rectal exam is not recommended in primary care due to the associated pain. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. For these patients, management of the underlying condition should also be optimised and referral initiated. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed. If an anal fissure is suspected to be secondary to a serious underlying condition, referral should be expedited.

• #49 Anal fissure: diagnosis, management, and referral in primary care | British Journal of General Practice

  https://bjgp.org/content/69/685/409

  Anal fissures are tears of the anal mucosa. […] Acute anal fissures are classified as lasting 6 weeks, whereas chronic fissures last 6 weeks. […] Examination is best performed in the lateral position, gently parting the buttocks to visualise the anal canal. […] Digital rectal exam is not recommended in primary care due to the associated pain. […] Glyceryl trinitrate 0.2% or 0.4% rectal ointment can be prescribed to encourage healing of anal fissures. […] When medical therapy has failed, local injection of Botox is recommended. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. […] In all children with ongoing anal fissure for 2 weeks despite treatment. […] In adults with ongoing pain after 8 weeks. […] If a secondary fissure is suspected due to a condition which warrants referral; that is, colorectal cancer or inflammatory bowel disease. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed.

• #50 Anal fissure: diagnosis, management, and referral in primary care

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6650108/

  A common finding on examination is spasm of the anal canal due to hypertonia of the anal sphincter. Digital rectal exam is not recommended in primary care due to the associated pain. […] For fissures in unusual positions, in multiple locations, or not healing despite optimal conservative therapy, a secondary anal fissure should be suspected. For these patients, management of the underlying condition should also be optimised and referral initiated. […] If, after 8 weeks, medical therapy has not proven to be effective, referral to secondary care is welcomed. If an anal fissure is suspected to be secondary to a serious underlying condition, referral should be expedited.

• #51 Anal fissure – symptoms, causes, and treatments | healthdirect

  https://www.healthdirect.gov.au/anal-fissure

  An anal fissure is a small tear or split in the skin that lines the anus. […] You should see your doctor if there is blood on your stool, on your toilet paper or you have pain when you are doing a poo. […] How is an anal fissure diagnosed? […] Your doctor will ask about your symptoms and examine your anus. […] Your doctor may refer you to a colorectal surgeon if the cause of your symptoms is not clear, or your treatment isn’t working.

• #52 Anal Fissures – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526063/

  An anal fissure is a superficial tear in the skin distal to the dentate line. […] The diagnosis of an anal fissure is primarily clinical. Several treatment options exist, including medical management and surgical options. […] Evaluation of both acute and chronic anal fissures initially involves determining if it is a primary or secondary anal fissure. […] An anal fissure is a clinical diagnosis made essentially by physical exam alone, which must be done to rule out other possible causes of rectal pain. […] Acute anal fissures in low-risk patients typically do well with conservative management and resolve within a few days to a few weeks. However, some of these patients develop CAF, which requires pharmacological treatment or surgical management. […] The complications of anal fissures include bleeding, pain, infection, incontinence, and fistula formation, which is the most serious complication of anal fissures.

• #53 Anal Fissures – Causes, Diagnosis | The Haemorrhoid Clinic

  https://www.thehaemorrhoidclinic.com/conditions/anal-fissures/

  If you are experiencing any of these symptoms, it is essential to see your doctor as soon as possible for diagnosis and treatment. […] Anal fissures can often be treated successfully with simple measures such as lifestyle changes and medications or else anal fissure treatment. […] However, if they are left untreated, they may lead to further complications such as infection or abscesses. […] Medications that may be prescribed for anal fissures include stool softeners, topical anaesthetics (to numb the area), and muscle relaxants. […] If you are experiencing pain and discomfort from anal fissures, it is essential to seek medical help as soon as possible. […] However, if left untreated, anal fissures may lead to further complications.

• #54 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  How are anal fissures diagnosed? A healthcare provider will ask you about your symptoms, then try to see the fissure. You’ll lie on your belly or on your side while they gently separate your buttocks. If this is too painful, they don’t have to go further. They can safely assume that you have an anal fissure. […] But if you can tolerate an exam, they’ll try to see the fissure so that they can rule out other possible causes for your symptoms. They might gently insert a lubricated gloved finger to open your anus, noticing any tenderness or muscle spasms. This is a digital rectal exam. […] Most anal fissures heal within a few days to weeks. A chronic anal fissure lasts more than eight weeks. If you’re in treatment for a chronic anal fissure, it may take another six to 12 weeks for the treatment to work and the fissure to finally heal. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues.

• #55 How Will the Doctor Diagnose and Treat an Anal Fissure?

  https://lacolon.com/article/will-doctor-diagnose-treat-anal-fissure

  If the fissure needs additional help healing, doctors may prescribe prescription drugs alongside conservative treatments. […] When conservative and non-invasive treatments fail to heal an anal fissure, surgery may be necessary. In most cases, a lateral sphincterotomy is used to allow the anal canal to heal. […] This is by far the most effective treatment for anal fissures, but there are risks associated with general anesthesia, as well as a small risk of fecal incontinence after the surgery. […] Less than ten percent of patients have a recurrence after surgery to treat an anal fissure, and the chances of recurrence are even lower for those who had a fissurectomy as well.

• #56 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  A healthcare professional will likely ask about medical history and perform a physical exam, including a gentle inspection of the anal region. Often the tear is visible. Usually, this exam is all that’s needed to diagnose an anal fissure. […] A fissure is considered chronic if it lasts more than eight weeks. […] A medical professional may recommend further testing to find out if there is an underlying condition. Tests may include: […] Colonoscopy may be done for someone who: […] Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.

• #57 Anal Fissure – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/general/anorectal/anal-fissure/

  In patients with ongoing symptoms despite these measures, a lateral sphincterotomy can be performed, involving division of the internal anal sphincter muscle. […] Recurrence of anal fissures post-surgery occurs approximately in 1-5% patients. […] Anal fissures present with intense pain post-defecation, as well as potential bleeding or itching. Risk factors include constipation and IBD. Most cases can be managed conservatively with medical management. Consider investigating for underlying causes for those with anterior fissures or recurrent disease.

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