https://wikem.org/w/index.php?action=history&feed=atom&title=Anal_fissure%2FenAnal fissure/en - Revision history2026-04-17T18:06:18ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Anal_fissure/en&diff=379879&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T20:47:57Z<p>Updating to match new version of source page</p>
<p><b>New page</b></p><div><languages/><br />
<br />
==Background==<br />
<br />
[[File:Human anus-en.png|thumb|Anatomy of the anus.]]<br />
[[File:Gynecological diagnosis (1910) (14798113703).jpg|thumb|Anatomy of anal fissure.]]<br />
*Superficial linear tear of anal canal from at/below dentate line to anal verge<br />
**May be due to passage of hard stool, frequent diarrhea, or abuse<br />
*Most common cause of painful rectal bleeding<br />
*In >90% of cases anal fissures occur in the midline posteriorly<br />
**Non-healing fissure or one not located in midline suggests alternative diagnosis (e.g. Crohn's, malignancy)<br />
<br />
<br />
==Clinical Findings==<br />
<br />
[[File:Anal fissure 2.jpg|thumb|Close up photo of anal fissure (at red arrow).]]<br />
*Acute sharp, cutting pain most severe during and immediately after bowel movement<br />
**Subsides between bowel movements (distinguishes fissure from other anorectal disease)<br />
*Bright red [[Special:MyLanguage/rectal bleeding|rectal bleeding]], small in quantity (usually noticed only on toilet paper)<br />
*Lateral to anus often indicates associated systemic illness such as [[Special:MyLanguage/Crohn's|Crohn's]], [[Special:MyLanguage/HIV|HIV]], [[Special:MyLanguage/leukemia|leukemia]], [[Special:MyLanguage/TB|TB]], [[Special:MyLanguage/syphilis|syphilis]]<br />
<br />
<br />
==Differential Diagnosis==<br />
<br />
{{Anorectal DDX}}<br />
<br />
{{Lower GI bleeding DDX}}<br />
<br />
<br />
==Evaluation==<br />
<br />
<br />
===Workup===<br />
<br />
*Typically clinical (no studies needed)<br />
<br />
<br />
===Diagnosis===<br />
<br />
*Having patient bear down may make fissure more noticable<br />
*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity<br />
**Often misdiagnosed as an external [[Special:MyLanguage/hemorrhoid|hemorrhoid]]<br />
<br />
<br />
==Management==<br />
<br />
*Warm sitz baths 15 min TID-QID and after each bowel movement<br />
**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm<br />
*Topicals<br />
**Pain control with [[Special:MyLanguage/lidocaine|lidocaine]]<br />
**Vasodilators such as [[Special:MyLanguage/nitroglycerin|nitroglycerin]] or [[Special:MyLanguage/nifedipine|nifedipine]] ointment<br />
**[[Special:MyLanguage/Hydrocortisone|Hydrocortisone]] <br />
*High-fiber diet<br />
**Prevents stricture formation by providing a bulky stool<br />
*Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly<br />
*Surgical referral indicated if healing does not occur in a reasonable amount of time<br />
<br />
<br />
==Complications==<br />
<br />
*[[Special:MyLanguage/Anorectal abscess|Anorectal abscess]]<br />
<br />
<br />
==Disposition==<br />
<br />
*Most patients can be managed medically and discharged with outpatient follow-up<br />
<br />
<br />
==See Also==<br />
<br />
*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]<br />
<br />
<br />
==External Links==<br />
<br />
*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]<br />
*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED] <br />
<br />
<br />
==References==<br />
<br />
<references/><br />
<br />
<br />
[[Category:GI]]</div>FuzzyBot