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How Anal Fissures are Diagnosed

An anal fissure is a tear in the lining of the anus or anal canal. They are very common and can be caused by any trauma or injury that stretches and tears the anus.

Symptoms of an anal fissure include:

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  • a visible tear in the 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

These symptoms can easily be mistaken as signs of other conditions, such as hemorrhoids.

Many people may not be comfortable reporting these problems to a doctor. But it is important to let your doctor know about these issues, so that more serious conditions can be ruled out.

Preparing for Your Doctor's Visit

In most cases, reporting your symptoms can give your doctor enough information to suspect anal fissure. If you've experienced any of the aforementioned symptoms, be sure to let your doctor know:

  • when you have pain, burning, or itching
  • how severe your discomfort is
  • how long the pain and discomfort usually lasts
  • what type of bleeding you've noticed
  • 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.

Physical Exam for Anal Fissures

Diagnosis of anal fissure can usually be made from the symptoms you report to your doctor. But the best way to determine whether or not you have an anal fissure is through a physical exam. After gently spreading the buttocks, your doctor may visually inspect the area for a fissure.

A rectal exam (using a gloved finger to digitally inspect the anus) or an anoscopy (inserting a lighted scope into the anal canal) can usually be avoided, although they are sometimes necessary.

Additional Testing for Anal Fissures

Generally, a visual exam of the area is all it takes. But if your doctor thinks an inflammatory bowel disease has contributed to the development of anal fissures, more testing may be needed. Often, the number and location of anal fissures can point to any underlying issues, such as Crohn’s disease. The presence of a skin tag at one end of a fissure may also point to chronic anal fissures.

If the diagnosis is not clear after a visual exam, your doctor may recommend a sigmoidoscopy to inspect the lower part of the colon, or the sigmond colon. Or a colonoscopy may be recommended to view the entire large intestine. Both tests involve inserting a long, thin, flexible, lighted tube into the anus to view the colon. These tests are used to identify abnormal growths or inflammatory conditions.

Questions to Ask Your Doctor

Once anal fissure has been diagnosed, be sure to ask your doctor these important questions.

  • Can I expect this fissure to heal on its own?
  • How can I treat an anal fissure at home?
  • Do I need medication?
  • Do I need to make changes to my diet?
  • How long should it take for the fissure to heal?
  • Am I likely to get more anal fissures?
  • Will I need surgery? What are the risks of surgery?

WebMD Medical Reference

Reviewed by Brunilda Nazario, MD on June 06, 2012

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