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
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- 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.[3]
- Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine gel to examine, and rule out internal hemorrhoids.[4][5]
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.[5]
- 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).[6]
Neuromuscular
- Neuromuscular examination of patients with anal fissure is usually normal.
Extremities
- Extremities examination of patients with anal fissure is usually normal.
References
- ↑ https://commons.wikimedia.org/w/index.php?curid=8885756
- ↑ https://commons.wikimedia.org/w/index.php?curid=5148617
- ↑ Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ (2005). "Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable". Dis. Colon Rectum. 48 (2): 349–52. doi:10.1007/s10350-004-0753-2. PMID 15812586.
- ↑ Davies D, Bailey J (2017). "Diagnosis and Management of Anorectal Disorders in the Primary Care Setting". Prim. Care. 44 (4): 709–720. doi:10.1016/j.pop.2017.07.012. PMID 29132530.
- ↑ 5.0 5.1 Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
- ↑ Bope, Edward (2018). Conn's current therapy 2018. Philadelphia: Elsevier. ISBN 978-0323527699.