Gastroenterology Search
Gastroenterology Gastroenterology
anal%20fissure
ANAL FISSURE
An anal fissure is a disruption of the skin at the distal anal canal.
Most fissures are seen by separating the buttocks with opposing traction of the thumbs.
Majority of fissures are located in the posterior midline of the anus.
Acute fissures are simple splits or cracks in the anoderm while chronic fissures may show secondary changes eg sentinel tag, hypertrophied anal papilla, rolled edges, fibrosis of the edges or deep ulceration with exposure of the underlying internal sphincter muscle.

Definition

Acute vs Chronic Fissures

  • Acute fissures are simple splits or cracks in the anoderm
    • Fissures that have not healed after 6 weeks are considered chronic
  • Chronic fissures may show secondary changes eg sentinel tag, hypertrophied anal papilla, rolled edges, fibrosis of the edges or deep ulceration with exposure of the underlying internal sphincter muscle

Signs and Symptoms

Symptoms of anal fissure elicited on history are often specific:

  • Severe pain during bowel movement
    • Patients may describe defecation as feeling like passing razor blades
    • Pain or burning may continue for several hours after defecation
  • Bright red blood may be seen with the stool or on the toilet tissue, but profuse bleeding is rare
  • Trauma during defecation, usually from passage of a hard stool or explosive diarrhea, is thought to set off anal fissure formation
  • Childbirth can also cause trauma to the anal canal
  • Fissure occurs more commonly in young adults and affects males and females equally
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Drug holiday for osteoporosis: Who, when, how long?
Elvira Manzano, 2 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
Low-fat dietary pattern may improve breast cancer survival
07 Oct 2017
Women who follow a low-fat dietary pattern appear to have reduced breast cancer mortality, according to data from the Earlier Women’s Health Initiative Dietary Modification trial.
GUSTO: Maternal tryptophan levels tied to sleep quality in pregnancy
Pearl Toh, 6 days ago
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.
Second eye cataract surgery improves vision, QoL better than first eye surgery alone
4 days ago
Second eye cataract surgery provides greater improvement in visual function and quality of life compared with first eye cataract surgery alone, a recent study claims.