Editing Fissure-in-ano (section)

== '''Examination''' ==

* Generally quite evident visually, even with gentle separation of buttocks from outside
* Small, shallow anal ulcer with sentinel pile and oedema
* Puckering of anal skin due to intense spasm
* Digital exam often impossible - no need for it if severe pain, because you should be able to see it
** Often possible in chronic fissure, along with proctoscopy
** If you really want to examine, you can inject 2mL of lignocaine just under the fissure, and usually permits DRE
* 95% of all fissures are in the midline
* Usually posterior midline in men (>80% of all fissures for men)
* Anterior midline is proportionally more common in women (up to 20% of all fissures in women)
** These anterior fissures are commonly associated with an external sphincter defect
** Anterior fissures in young women could be secondary to obstetric trauma - the 'low-pressure' fissure, which is treated slightly differently