How is it Diagnosed?
An anal fissure is diagnosed primarily through a physical examination and patient
history. Patients typically report sharp pain during or after defecation, bleeding (usually
bright red), and sometimes itching or a visible tear in the anal region.
The doctor begins by visually inspecting the anus and surrounding skin for a linear tear,
usually located in the posterior midline. Gentle digital rectal examination or use of an
anoscope may be attempted if pain allows, although in many cases this is deferred to
avoid discomfort.
In chronic fissures, findings may include skin tags (sentinel pile) or hypertrophied anal
papillae. Recurrent or non-healing fissures may raise suspicion of underlying conditions
such as Crohn’s disease, HIV, tuberculosis, syphilis, or malignancy.
If the fissure appears atypical in location (lateral fissure) or persistent beyond 6–8
weeks, additional investigations like colonoscopy may be warranted, especially in older
adults or those with alarming symptoms like weight loss or altered bowel habits.
Blood tests may be performed to rule out infections or systemic diseases, and stool
tests may be used to check for occult blood or infections in recurrent cases.
Diagnosis is typically straightforward and mainly clinical, but refractory or atypical
fissures require further evaluation to exclude other underlying conditions.