Anal Fissure

Basics

Description

  • 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 at distal aspect of the fissure
    • Internally: Forms hypertrophied anal papilla
    • Chronic fissure may reveal hypertrophied anal papilla proximally

Etiology

  • 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 disease
    • Anal cancer
    • Leukemia
    • Syphilis
    • Previous anal surgery

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