History and exam

Key diagnostic factors

common

pain on defecation

Reported by 90% of patients.[17]

tearing sensation on passing stool

Reported by 60% of patients.[17]

fresh blood on stool or on paper

Reported by 60% of patients.[17]

anal spasm

Reported by 70% of patients.[17]

Other diagnostic factors

common

intermittent symptoms

Symptoms tend to wax and wane. Reported by 60% of patients.[17]

uncommon

sentinel pile

Reported in 20% of patients.[17]

fissure visible on retraction of buttock

Reported in 40% of patients.[17]

Risk factors

strong

hard stool

Passage of a hard stool may tear the skin in the distal anal canal, which is then unable to heal in some cases and so causes a chronic fissure.[2][3]

pregnancy

Fissure may occur in the third trimester or after delivery. The exact mechanism for appearance of fissure in the third trimester is not known.

opiate analgesia

Opiate analgesia causes constipation, and constipation is associated with development of anal fissure.[4]​

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