Anal fissure is a very disturbing and painful condition most commonly occurs in young patients, however it may present at any age. It is a longitudinal tear in the anal canal below the level of the dentate line. Cause, more commonly is the constipation and less commonly repeated passage of diarrhoea.
Patient complains of severe pain during defecation (Painful stool) and after defecation which may remains for many hours due to spasm of anal sphincters which causes ischemia.
Other symptom is bleeding per rectum. Blood bright red in colour, comes in a streak along the stool.
On examination a longitudinal ulcer is seen at anal canal more commonly at 6 O' clock and less commonly at 12 O' clock. Anal fissure at 12 O' clock is usually seen in females after vaginal delivery.
Multiple fissures away from these sites suggest other pathology, like inflammatory bowel disease (Crohn's disease), tuberculosis, sexually transmitted related ulcers or squamous cell carcinoma. Digital rectal examination (DRE) and proctoscopy are containdicated.
Anal fissure may be acute or chronic. Chronic anal fissure is characterised by a hypertrophied anal papilla internally and a sentinel tag externally.
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