Anal fissure physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

Patients with anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins.

Physical Examination

• Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure.

Appearance of the patient

• Patients with anal fissure usually appear in pain.

Vital Signs

• Tachycardia with regular pulse (in pain).

Skin

• Skin examination of patients with anal fissure:
  • Perianal skin can be inflamed.

HEENT

• HEENT examination of patients with anal fissure is usually normal.

Neck

• Neck examination of patients with anal fissure is usually normal.

Lungs

• Pulmonary examination of patients with anal fissure is usually normal.

Heart

• Cardiovascular examination of patients with anal fissure is usually normal.

Abdomen

• Abdominal examination of patients with anal fissure is usually normal.

Back

• Back examination of patients with anal fissure is usually normal.

Genitourinary

• Genitourinary examination of patients with anal fissure is usually normal.

Local/anal examination

By Bernardo Gui - Own work, Public Domain

By Jonathanlund - Own work, Public Domain

• The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.
• Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine gel to examine, and rule out internal hemorrhoids.

Inspection

• On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
• Acute anal fissures appear as fresh laceration while chronic have raised margins.
• Chronic anal fissures may have a skin tag also.

Palpation

• Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine.
• Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the buttocks).

Neuromuscular

• Neuromuscular examination of patients with anal fissure is usually normal.

Extremities

• Extremities examination of patients with anal fissure is usually normal.
  

References

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