If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube anoscope to inspect your anal canal. However, if this is too painful for you, your doctor may be able to diagnose an anal fissure only by observation.
An acute anal fissure looks like a fresh tear, somewhat like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps or tags of skin, one internal sentinel pile and one external hypertrophied papilla.
The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. Your doctor may recommend further testing if he or she thinks you have an underlying condition:.
Anal fissures often heal within a few weeks if you take steps to keep your stool soft, such as increasing your intake of fiber and fluids. Soaking in warm water for 10 to 20 minutes several times a day, especially after bowel movements, can help relax the sphincter and promote healing.
If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery.
Doctors usually perform a procedure called lateral internal sphincterotomy LISwhich involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain, and promote healing.
Studies have found that for chronic fissure, surgery is much more effective than any medical treatment. However, surgery has a small risk of causing incontinence. Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent recurrences:. If your infant has an anal fissure, be sure to change diapers frequently, wash the area gently and discuss the problem with your child's doctor. If you have an anal fissure, you may be referred to a doctor who specializes in digestive diseases gastroenterologist or a colon and rectal surgeon.
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When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:. Take a family member or friend along, if possible, to help you remember the information you're given.
While you're waiting to see your doctor, take steps to avoid constipation, such as drinking plenty of water, adding fiber to your diet and exercising regularly. Also, avoid straining during bowel movements.
The extra pressure may lengthen the fissure or create a new one. Your doctor will likely ask about your medical history and perform a physical exam, including inspection of the anal region. Often the tear is visible.
Usually this exam is all that's needed to diagnose an anal fissure. Anal fissure care at Mayo Clinic.
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Diagnosis If possible, your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube anoscope to inspect your anal canal.
Request an Appointment at Mayo Clinic. References Feldman M, et al.
Diseases of the anorectum. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: American Society of Colon and Rectal Surgeons.
Wald A, et al. Management of benign anorectal disorders. American Journal of Gastroenterology.
Perry WB, et al. Practice parameters for the management of anal fissures 3rd revision.
Nelson RL, et al. Non surgical therapy for anal fissure. Cochrane Database of Systematic Reviews.