Anal Fistulas and Fissures Workup

Updated: May 27, 2022
  • Author: Bruce M Lo, MD, MBA, RDMS, FACEP, FAAEM, FACHE, FAAPL, CPE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Approach Considerations

Diagnosis of an anal fissure is primarily based on the history and physical examination. No specific testing is needed for diagnosing anal fissures unless atypical or multiple fissures are present, suggesting either an infectious or other etiology.

Evaluation of an anal fistula depends on the clinical status of the patient. If a concurrent abscess is present, and the location and size is not well characterized, advanced imaging may be needed. Blood work should be reserved for patients with clinical signs of sepsis or those who appear toxic. Wound culture may also be indicated if there is concern for possible infectious etiologies such as syphilis or HIV infection. If clinically warranted, a workup for other etiologies such as Crohn disease may be indicated.

If the extent of the fistula is not well characterized by physical examination, advanced diagnostics may be indicated to evaluate the anatomy of a complex fistula.