clinical features
Last reviewed 01/2018
The salient features of fissure in ano are:
- history of pain of defaecation - often first occurs during a period of constipation
- the passing of stools may cause sphincter spasm and acute pain during defaecation, which may persist for up to an hour
- patient may develop a fear of defaecation which in turn aggravates the constipation; even sitting may be avoided
- there is often fresh rectal bleeding at defaecation; the patient complains of 'bright red blood on the paper'
On examination:
- there is a longitudinal tear that nearly always occurs directly posteriorly and in the midline
- a sentinel pile may be seen if the anus is inspected with the buttocks gently parted; the sentinel pile is the torn, bunched-up strip of mucosa at the base of the fissure
The severity of the pain and muscle spasm may preclude digital examination and necessitate examination under general anaesthesia.