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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 anal sphincter muscle within the fissure's base.

Definition

Acute vs Chronic Fissures

  • Acute fissures are simple splits or cracks in the anoderm present for <8 weeks 
    • Fissures that have not healed after 6 weeks are considered chronic
  • Chronic fissures may show secondary changes eg sentinel tag at the fissure’s distal aspect, hypertrophied anal papilla at the fissure’s proximal aspect, rolled edges, fibrosis of the edges or deep ulceration with exposure of the underlying internal anal sphincter muscle within the fissure’s base

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
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