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Anal fissure: Clinical manifestations, diagnosis, prevention

David B Stewart, MD, FACS, FASCRS
Section Editors
Martin Weiser, MD
Lawrence S Friedman, MD
Deputy Editor
Wenliang Chen, MD, PhD


Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding.

The pathogenesis, clinical manifestations, diagnosis, and prevention of primary sporadic anal fissure are discussed in this topic, while the medical and surgical treatment is presented in other topics. (See "Anal fissure: Medical management" and "Anal fissure: Surgical management".)

Secondary causes of anal fissures are discussed separately. (See "Perianal complications of Crohn disease" and "Cutaneous manifestations of tuberculosis", section on 'Metastatic tuberculous abscesses (tuberculous gummas)'.)


Anal fissures most often affect infants and middle-age individuals. It is estimated that approximately 235,000 new cases of anal fissure occur every year in the United States [1]. However, a more precise incidence cannot be established because anal discomfort is often misattributed to symptomatic hemorrhoids [2].


Anal fissures typically start with a tear to the anoderm within the distal half of the anal canal. The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients [1]. The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

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Literature review current through: Nov 2017. | This topic last updated: Dec 09, 2017.
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