Gut Instincts: A Clinician's Handbook of Digestive and Liver Diseases

Eric Esrailian, MD, MPH

Chapter 30: Fissures, Fistulae, And Condyloma (continued)

Jonathan Sack, MD

Anal fissure is a radial tear in the anoderm that occurs due to local trauma, most commonly, passage of a large, hard stool. Painful defecation, often with bleeding, is characteristic. There can be both an initial sharp pain with hematochezia and a postdefecatory spastic pain, which can persist for several hours. Spasm of the internal anal sphincter produces relative cutaneous ischemia, which impairs healing. Most acute anal fissures heal spontaneously, but if an acute fissure fails to heal within 6 weeks, it is termed a chronic anal fissure. Approximately 90% of typical anal fissures are…