eMedicine Specialties > Pediatrics: Surgery > General Surgery

Anal Fissure: Workup

Author: Brian P Gillett, MD, Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center
Coauthor(s): Charles N Paidas, MD, MBA, Professor of Surgery and Pediatrics, University of South Florida; Chief of Pediatric Surgery, Tampa General Hospital
Contributor Information and Disclosures

Updated: Mar 2, 2010

Workup

Laboratory Studies

  • Laboratory and imaging studies are not routinely necessary in the workup of an anal fissure. However, if the clinician suspects the presence of an underlying disease process, additional tests are indicated, such as serology, purified protein derivative of tuberculin (PPD), stool cultures, biopsy, or further GI workup.

Imaging Studies

  • An abdominal flat radiograph to check for constipation is often illustrative and serves as a baseline examination before beginning stool softeners.

More on Anal Fissure

Overview: Anal Fissure
Workup: Anal Fissure
Treatment: Anal Fissure
Follow-up: Anal Fissure
References

References

  1. Brown CJ, Dubreuil D, Santoro L, Liu M, O'Connor BI, McLeod RS. Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum. Apr 2007;50(4):442-8. [Medline].

  2. Demirbag S, Tander B, Atabek C, et al. Long-term results of topical glyceryl trinitrate ointment in children with anal fissure. Ann Trop Paediatr. Jun 2005;25(2):135-7. [Medline].

  3. Agnarsson U, Warde C, McCarthy G, Evans N. Perianal appearances associated with constipation. Arch Dis Child. Nov 1990;65(11):1231-4. [Medline].

  4. Burd RS, Price MR. Evaluation and initial management of miscellaneous pediatric surgical problems. Pediatr Ann. 2001;30(12):752-9. [Medline].

  5. Cook RC. Anal fissure and anal fistula. In: Spitz L, Coran AG, eds. Paediatric Surgery. Elsevier Health Sciences; 1995:515-9.

  6. Emami MH, Sayedyahossein S, Aslani A. Safety and efficacy of new glyceryl trinitrate suppository formula: first double blind placebo-controlled clinical trial. Dis Colon Rectum. Jul 2008;51(7):1079-83. [Medline].

  7. Garcia-Granero E, Sanahuja A, Garcia-Armengol J, et al. Anal endosonographic evaluation after closed lateral subcutaneous sphincterotomy. Dis Colon Rectum. May 1998;41(5):598-601. [Medline].

  8. Jonas M, Neal KR, Abercrombie JF, Scholefield JH. A randomized trial of oral vs. topical diltiazem for chronic anal fissures. Dis Colon Rectum. Aug 2001;44(8):1074-8. [Medline].

  9. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. Jan 1989;32(1):43-52. [Medline].

  10. Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg. Apr 2001;88(4):553-6. [Medline].

  11. Motson RW, Clifton MA. Pathogenesis and treatment of anal fissure. In: Henry MM, Swash M, eds. Coloproctology and the Pelvic Floor. Butterworth-Heinemann; 1985:340-9.

  12. Parellada C. Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up. Dis Colon Rectum. Apr 2004;47(4):437-43. [Medline].

  13. Pena A. Surgical conditions of the anus, rectum, and colon. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders Co; 2000:1181-3.

  14. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XV. Chronic anal fissure: a new theory of pathogenesis. Am J Surg. Aug 1982;144(2):262-8. [Medline].

  15. Sonmez K, Demirogullari B, Ekingen G, et al. Randomized, placebo-controlled treatment of anal fissure by lidocaine,EMLA, and GTN in children. J Pediatr Surg. Sep 2002;37(9):1313-6. [Medline].

  16. Stafford PW. Anal fissure. In: O'Neill JA, Rowe MI, Grosfeld JL, et al, eds. Pediatric Surgery. Elsevier Health Sciences; 1998:1454-5.

  17. Tander B, Guven A, Demirbag S, et al. A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure. J Pediatr Surg. Dec 1999;34(12):1810-2. [Medline].

Further Reading

Keywords

anal fissure, fissure in ano, anal tear, tear of the squamous epithelial mucosa of the anal canal, tear of the anal canal, bright rectal bleeding, posterior midline tear, constipation, anorectal pain, passage of hard stool, blood in the stool, anorectal blood, rectal blood, rectal bleeding, anal skin tag, chronic ulcer, acquired immunodeficiency syndrome, chlamydia, gonorrhea, syphilis, neoplasm, sexual abuse, inflammatory bowel disease

Contributor Information and Disclosures

Author

Brian P Gillett, MD, Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center
Brian P Gillett, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Charles N Paidas, MD, MBA, Professor of Surgery and Pediatrics, University of South Florida; Chief of Pediatric Surgery, Tampa General Hospital
Charles N Paidas, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American College of Surgeons, American Heart Association, American Pediatric Surgical Association, Association for Academic Surgery, Florida Pediatric Society, Johns Hopkins Medical and Surgical Association, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Aviva L Katz, MD, Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh
Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Gail E Besner, MD, John E Wilson Endowed Professor of Neonatal Research, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine; Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital
Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

H Biemann Othersen Jr, MD, Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina
H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Chief Editor

Philip Glick, MD, MBA, Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Finance and Development, Department of Surgery, State University of New York at Buffalo
Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons
Disclosure: Nothing to disclose.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.