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Tests and diagnosis
By Mayo Clinic staffYour doctor will ask you for your medical history and perform a physical exam, including inspection of the anal region. Often, the tear is visible.
Your doctor may refrain from performing a rectal exam, which involves inserting a gloved finger or a small instrument into your anal canal, because it may be too painful.
However, after your anal fissure has healed and especially if you've had rectal bleeding, your doctor may recommend further testing, usually a sigmoidoscopy or colonoscopy, to be sure no underlying disorder such as Crohn's disease or colorectal cancer caused your anal fissure. Both tests involve inserting a thin, flexible tube into your rectum. A tiny video camera allows your doctor to see inside your rectum and colon. To prepare for either test, you'll need to clean your colon, which means you need to avoid solid or opaque foods for 24 hours before the test, and you'll need to take laxatives or enemas as prescribed by your doctor. Most people also choose to have some form of anesthesia during these procedures.
If you're 50 or older, your doctor likely will recommend a colonoscopy, which allows viewing of the entire colon and also serves as a screen for colorectal cancer, another possible cause of rectal bleeding. If you're younger than 50 and have no risk factors for intestinal diseases or colon cancer, your doctor may recommend the less invasive sigmoidoscopy, which allows viewing of only the bottom portion of the colon.
