B. Anal fissure – Explanation

Anal fissures are caused by constipation and straining. Patients often remember the
episode of pain when the tear occurred. The pain is so severe tht they would refuse
rectal examinations.

The distractor here is anal abscesses and haemorrhoids. Anal abscesses present with
painful swelling and defecation can be painful however blood is not typical.
Haemorrhoids may also present similarly with pain and bleeding (like anal fissures)
however the symptoms of pain are usually intermittent (unless thrombosed where the
pain is acutely severe) and do not tend to appear as streaks of blood on stools.

ANAL FISSURE
Anal fissures are longitudinal or elliptical tears of the squamous lining of the distal anal
canal.

• exquisite pain with defecation and blood streaks covering the stools
• The fear of pain is so intense that they avoid bowel movements (and getconstipated)
• refuse proper examination of area → thus exam needs to be done underanaesthesia

If present for less than 6 weeks → defined as acute
If present for more than 6 weeks → defined as chronic