Diagnostics

• Sharp, severe pain during defecation

• Rectal bleeding (often bright red and minimal; should not be confused with other types of bleeding such as in colorectal cancer or hemorrhoids)

• Perianal pruritus

• Chronic constipation

The rule of anal fissure D's: Distally to the Dentate line; bleeDing During Defecation; Dull puDenDal pain; Diet low in fiber

• Clinical examination

  • Superficial or deep laceration in anterior, lateral, or posterior anal canal

  • In addition, chronic fissures may present with fibrotic and infective changes:

    • Wide, raised edges

    • Skin tags (sentinel pile) at the fissure's distal end

    • Hypertrophied anal papillae at the fissure's proximal end

• Clinical history: see “Etiology” and “Clinical features” above

• Digital rectal examination: if diagnosis is uncertain or to exclude a suspected underlying pathology (e.g., rectal tumor)

• Anoscopy

  • Indicated if clinical findings are unclear or if symptoms persist despite adequate treatment

  • Possible biopsy and histological investigation (to exclude a carcinoma, especially when presentation is atypical)

• Perianal ulcer

• Anal fistula or abscess

• Anal carcinoma