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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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.

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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