Anal Fissure (cont.)
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Anal Fissure Diagnosis
The diagnosis of anal fissure is most commonly made after the health care practitioner takes a history of the patient's complaint and performs a physical examination. The history of constipation followed by a painful bowel movement and rectal pain that continues afterwards is often enough to make the preliminary diagnosis.
Physical examination is usually limited to inspection of the anus, looking for the crack or tear in the skin surrounding the anus. Because of the amount of pain and discomfort, the rectal examination, where a finger is inserted into the rectum to feel for abnormalities and to check for blood in the stool, is usually deferred.
If the fissure is not seen and there is doubt about the diagnosis, a flexible sigmoidoscopy may be considered, where the health care practitioner inserts a short lighted tube into the anus to inspect the area. Usually, lidocaine ointment is used as an anesthetic to make the procedure less uncomfortable.
No other blood tests or X-rays are needed.
Anal fissures that are due to constipation usually are found in the midline. If the fissure is located off to the side, other underlying medical conditions may be the cause, including Crohn's disease (a type of inflammatory bowel disease), HIV infection, and cancer.
Bhupinder Anand, MD
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