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How Anal Fissures Are Diagnosed

An anal fissure is a tear in the lining of your anus or anal canal. They're common, and they can be caused by any trauma or injury that stretches and tears the anus.

Symptoms include:

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  • A visible tear in your anus
  • Pain during, and even after, bowel movements
  • Small amounts of blood on the surface of stools and toilet paper
  • Burning and itching around the anus
  • Smelly discharge

You can easily mistake these symptoms as signs of other conditions, such as hemorrhoids.

You might not be comfortable telling these problems to a doctor, but it's important to do so. That way, your doctor can rule out more serious conditions.

What to Tell Your Doctor

In most cases, discussing your symptoms can give your doctor enough information to diagnose an anal fissure. If you've had any of the symptoms, be sure to tell her:

  • When you have pain, burning, or itching
  • How bad your discomfort is
  • How long the pain and discomfort usually lasts
  • What type of bleeding you've seen
  • What, if anything, improves your symptoms

Your doctor may ask you about your diet, bowel habits, and if you have any other medical conditions or intestinal problems.

Exam

Even though your doctor can usually diagnose an anal fissure from the symptoms you tell her, the best way to learn whether or not you have one is through a physical exam. Your doctor may look at the area for a fissure.

You probably won't need a rectal exam (when the doctor uses a gloved finger to feel inside the anus) or an anoscopy (when the doctor puts a lighted scope into the anal canal). Sometimes they're necessary, though.

Further Testing

Generally, a visual exam of the area is all it takes. But if your doctor thinks an inflammatory bowel disease has led to the anal fissure, you might need more tests. Often, the number and location of anal fissures can point to other conditions, like Crohn’s disease. The presence of a skin tag at one end of a fissure may also point to chronic anal fissures.

Your doctor might also suggest a test called a sigmoidoscopy to see the lower part of the colon, or the sigmoid colon. Or, you may need a colonoscopy to look at the whole large intestine. Both tests involve inserting a long, thin, flexible, lighted tube into your anus to view the colon. They're used to look for abnormal growths or inflammatory conditions.

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