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- Hard stool passes and “cuts” anoderm
- Linear tear extends from dentate line to anoderm:
- Posterior midline 95%
- Anterior midline 5%
- Externally: Forms skin tag or sentinel pile
- Internally: Forms hypertrophied anal papilla
- Chronic fissure may reveal fibers of internal sphincter with sentinel pile.
- Stress or an overly tight anal sphincter leads to local ischemia of posterior anoderm.
- Diarrhea or hard bowel movement tears anoderm.
- Local trauma from anal intercourse or sexual abuse may be the cause.
- Lateral fissures indicate underlying causative systemic disease:
- Crohn's disease
- Anal cancer
- Previous anal surgery
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