Anal Fissure Workup

  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jan 10, 2012
 

Laboratory Studies

  • If an ordinary anal fissure is suggested and if it is located in the posterior or anterior midline, then no laboratory tests are necessary. If the fissure is off the midline or irregular, or if an underlying illness (eg, Crohn disease, squamous cell cancer, AIDS[4] ) may be present, then the appropriate tests should be ordered; these may include erythrocyte sedimentation rate, stool and viral cultures, human immunodeficiency virus (HIV) testing, and biopsy of the lesion/fissure (as warranted).
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Imaging Studies

  • No imaging studies are required for the diagnosis and treatment of anal fissures.
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Diagnostic Procedures

  • Along with a history, the diagnosis can usually be made based on findings from a gentle perianal examination with inspection of the anal mucosa. In this case, no diagnostic procedures are required. A digital rectal examination is painful and often can be deferred.
    • Occasionally, the fissure is not easily visualized and anoscopy is required to see it. However, this is not well tolerated by a patient with an acute anal fissure, and anoscopy can often be deferred, with the patient treated based only on symptoms. Occasionally, a topical application of 1-2% lidocaine facilitates the examination.
    • Patients who do not heal, those who have relief from symptoms with appropriate therapy, or those who have a recurrent anal fissure after surgical therapy should be evaluated further with anoscopy and rigid proctosigmoidoscopy to exclude other pathologies. Patients with chronic fissures tend to have less pain and can better tolerate either anoscopy or rigid proctosigmoidoscopy and should have this included in their evaluation.
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Histologic Findings

The fissure is not usually excised; therefore, no pathology specimen is available for examination. When it is excised, the tissue typically exhibits nonspecific inflammation. If some of the muscle is accidentally excised with the fissure, the internal sphincter usually demonstrates fibrosis.

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Contributor Information and Disclosures
Author

Lisa Susan Poritz, MD  Associate Professor of Surgery and Cellular and Molecular Physiology, Director, Colon and Rectal Research, Department of Surgery, Division of Colon and Rectal Surgery, Milton S Hershey Medical Center, Pennsylvania State University College of Medicine

Lisa Susan Poritz, MD is a member of the following medical societies: American College of Surgeons, American Physiological Society, American Society of Colon and Rectal Surgeons, Association for Academic Surgery, Association of Women Surgeons, Central Surgical Association, Society for Surgery of the Alimentary Tract, and Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

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Acute anal fissure.
Anal fissure.
 
 
 
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