An anal fissure fissure-in-ano is a small, oval shaped tear in skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids. Anal fissures can occur at any age and have equal gender distribution. A small number of patients may actually have fissures in both the front and the back locations.
A patient presents with severe anal pain, lasting hours after each bowel movement. She notices some intermittent bleeding with defecation. She comes to the office with the presumed diagnosis of hemorrhoids. Are her symptoms consistent with hemorrhoidal disease, or does she have another disorder?
An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation, [1] but with chronic fissures, pain intensity often reduces. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location.