Anal fissure overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Historical Perspective
Classification
Anal fissures can be divided into primary and secondary anal fissures based on etiology, posterior and anterior anal fissures based on location, and acute and chronic anal fissures based on the duration of symptoms.
Pathophysiology
The exact pathogenesis of anal fissure is not fully understood but constipation or anal trauma was supposed to instigate the fissure. It is understood that anal fissure is the result of either anal trauma (by hard stools/diarrhea), perfusion defects with ischemia caused due to increased anal pressures and decreased blood flow or increased anal sphincter tone. In 90% of the patients, anal fissures are found in posterior midline. A small tear is seen that extends from dentate line to anal verge due to ischemia/poor perfusion of the area by inferior rectal artery (during increased sphincter tone).
Causes
Anal fissure are caused due to severe and chronic constipation, watery diarrhea and Crohn's disease. Anal fissures are common in women after childbirth, and following constipation in infants. Other less common causes include tuberculosis, sarcoidosis, anal intercourse, HIV , Human papillomavirus, and syphilis.
Differentiating Anal fissure overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Patients with anal fissure have a history of painful bowel movements and bleeding per rectum which can be seen as blood on tissue paper following a bowel movement. They usually have a history of constipation too but also some patients may report frequent episodes of watery diarrhea.They also have symptoms of painful defecation.Some patients may also have associated itching and irritation.