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Anal Fissure

Anal Fissure is a topic covered in the 5-Minute Emergency Consult.

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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
    • Leukemia
    • Syphilis
    • Previous anal surgery

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Rosen, Peter, et al., editors. "Anal Fissure." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307092/all/Anal_Fissure.
Anal Fissure. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307092/all/Anal_Fissure. Accessed April 26, 2019.
Anal Fissure. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307092/all/Anal_Fissure
Anal Fissure [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307092/all/Anal_Fissure.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Anal Fissure ID - 307092 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307092/all/Anal_Fissure PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -