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Tests and diagnosis
By Mayo Clinic staffYour doctor will likely ask you for your medical history and perform a physical exam, including inspection of the anal region. Often the tear is visible. Usually this is all that's needed to diagnose an anal fissure.
Your doctor may refrain from performing a rectal exam, which involves inserting a gloved finger into your anal canal, because it may be too painful. In some cases, however, your doctor may use a short, lighted tube (anoscope) to inspect your anal canal and see how far an anal fissure extends.
If your signs and symptoms suggest you might have an underlying disorder such as Crohn's disease or colorectal cancer, your doctor may recommend further testing:
- Flexible sigmoidoscopy. This test involves inserting a thin, flexible tube with a tiny video camera into the bottom portion of your colon. Flexible sigmoidoscopy may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
- Colonoscopy. In this test, the tube allows viewing of your entire colon. If you're 50 or older, your doctor likely will recommend a colonoscopy, which also screens for colon cancer.
- Anal manometry. In this test, your doctor inserts a narrow, flexible tube into your anus and rectum. Once the tube is in place, a small balloon at the tip of the tube may be expanded. This test lets your doctor know how tight your anal sphincter is. It also measures the sensitivity and function of your rectum.
- Gearhart SL. Diverticular disease and common anorectal disorders. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. New York, N.Y.: McGraw-Hill; 2008. http://www.accessmedicine.com/content.aspx?aID=2881328. Accessed July 28, 2010.
- Lacy BE, et al. Common anorectal disorders: Diagnosis and treatment. Current Gastroenterology Reports. 2009;11:413.
- Herzig D. Anal fissure. Surgical Clinics of North America. 2010;90:33.
- Greenwald DA. Common disorders of the anus and rectum: Hemorrhoids and fissures. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/hemorrhoids.asp. Accessed July 28, 2010.
- Yamada T, et al. Anorectal diseases. In: Yamada T, et al. Textbook of Gastroenterology. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003. http://ovidsp.tx.ovid.com/sp-2.3.1b/ovidweb.cgi. Accessed July 28, 2010.
- Breen E, et al. Anal fissures. http://www.uptodate.com/home/index.html. Accessed July 28, 2010.
- Anal fissure. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/patients/conditions/anal_fissure. Accessed July 28, 2010.
- Anal fissure. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec02/ch020/ch020.html. Accessed July 28, 2010.
- Gil J, et al. Screening for the effectiveness of conservative treatment in chronic anal fissure patients using anorectal manometry. International Journal of Colorectal Disease. 2010;25:649.
- Klein MD, et al. Surgical conditions of the anus, rectum, and colon. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/212152969-3/1032016749/1608/827.html#4-u1.0-B978-1-4160-2450-7..50343-1--cesec13_6840. Accessed July 28, 2010.
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