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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