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An anal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper and undergarments, or sometimes in the toilet. If acute they are painful after defecation , [ 1 ] but with chronic fissures, pain intensity often reduces and becomes cyclical.
Doctors uses a variety of tools and techniques to evaluate the type of anorectal disorder, including digital and anoscopic investigations, palpations, and palpitations.The initial examination can be painful because a gastroenterologist will need to spread the buttocks and probe the painful area, which may require a local anesthetic.
Two more highly common causes of functional anorectal pain are levator ani syndrome (LAS) and proctalgia fugax.Both of these conditions are thought to be caused by muscle spasms of the either the levator ani muscle or the anal sphincter muscle respectively, and may overlap symptomatically with a third less-common condition called coccygodynia which is the result of previous trauma to the ...
Generally, fissures are due to injury to the mucosa, or because of a poor local blood supply that prevents proper healing, with spasm of the external anal sphincter contributing. [9] The external anal sphincter can be relaxed by the application of glyceryl trinitrate creams, and constipation is managed with laxatives and improving hydration. [9]
As such, pain associated with constipation (either chronic, or acute), penetrative anal intercourse, trauma (such as tears or fissures of the rectal sphincter or anal canal), side-effects of some medications (particularly opiates), or rectal foreign body insertion preclude this diagnosis. The pain episode subsides by itself as the spasm ...
This examination may show anal fissures, prolapsed hemorrhoids, internal intussusception, rectal prolapse, or other anorectal lesions. Patients with occult rectal prolapse may show heperemia and edema of the anterior (front) rectal wall, colitis cystica profunda or solitary rectal ulcer syndrome (blood, mucus, area of erythema and ulceration).