How is an anal fissure diagnosed?

Your doctor can diagnose an anal fissure from your symptoms and a physical exam. The exam may include:

• Looking at the fissure by gently separating the buttocks.
• Digital rectal exam. The doctor uses a gloved finger to feel structures in the anal canal.
• Anoscopy. This exam involves using a short, lighted scope to look into the anal canal.

A doctor usually will wait until the fissure has begun healing before doing a digital rectal exam or anoscopy. If an exam needs to be done immediately, a topical anesthetic can be used to numb the area.

The location of a fissure is important in the diagnosis. If you have more than one fissure or have a fissure on the side of the anus (rather than at the top or the bottom), you may have another condition that is causing fissures. Possible conditions include inflammatory bowel disease (IBD), anal cancer, syphilis, tuberculosis, a suppressed immune system, or HIV infection.

A doctor may look for a small piece of loose skin (a skin tag) in the anus, often a sign of a long-term (chronic) fissure. Skin tags are often mistakenly identified as hemorrhoids.

Diagnosis is usually initiated because of bleeding or pain associated with defecation. The healthcare provider can usually diagnose an anal fissure based on medical history and a rectal or visual exam.

A rectal exam may involve the insertion of a gloved finger into the anal canal. However, this is often too painful, and a visual exam only may be conducted. The visual exam may employ a short, lighted tube called an anoscope.

If the tear is visible, a diagnosis can be made. If the tear is not visible, a sample of the rectal tissue can be taken.

Generally, other tests are not needed. However, if signs and symptoms also suggest an underlying inflammatory bowel disorder or colorectal cancer, or if the healthcare practitioner wants to rule out other disorders, other tests may be conducted. These include flexible sigmoidoscopy (the insertion of a thin, flexible tube with a tiny video camera into the sigmoid (bottom part of the colon)), colonoscopy (the insertion of a thin, flexible tube with a tiny video camera into the entire colon), and anal manometry (the insertion of a thin, flexible tube into the anus and rectum for the expansion of a balloon to determine the tightness of the anal sphincter and function of the rectum).

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