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

• 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