Anal fissure physical examination
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Overview
Patients with anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins.
Physical Examination
Physical Examination
- Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure.
Appearance of the patient
- Patients with anal fissure usually appear in pain.
Vital Signs
- Tachycardia with regular pulse (in pain).
Skin
- Skin examination of patients with anal fissure:
- Perianal skin can be inflamed.
HEENT
- HEENT examination of patients with anal fissure is usually normal.
Neck
- Neck examination of patients with anal fissure is usually normal.
Lungs
- Pulmonary examination of patients with anal fissure is usually normal.
Heart
- Cardiovascular examination of patients with anal fissure is usually normal.
Abdomen
- Abdominal examination of patients with anal fissure is usually normal.
Back
- Back examination of patients with anal fissure is usually normal.
Genitourinary
- Genitourinary examination of patients with anal fissure is usually normal.
Local/anal examination
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- The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.[3]
- Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine gel to examine, and rule out internal hemorrhoids.[4][5]
Inspection
- On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
- Acute anal fissures appear as fresh laceration while chronic have raised margins.[5]
- Chronic anal fissures may have a skin tag also.
Palpation
- Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine.
- Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the buttocks).[6]
Neuromuscular
- Neuromuscular examination of patients with anal fissure is usually normal.
Extremities
- Extremities examination of patients with anal fissure is usually normal.
References
References
- ↑ https://commons.wikimedia.org/w/index.php?curid=8885756
- ↑ https://commons.wikimedia.org/w/index.php?curid=5148617
- ↑ Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ (2005). “Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable”. Dis. Colon Rectum. 48 (2): 349–52. doi:10.1007/s10350-004-0753-2. PMID 15812586.
- ↑ Davies D, Bailey J (2017). “Diagnosis and Management of Anorectal Disorders in the Primary Care Setting”. Prim. Care. 44 (4): 709–720. doi:10.1016/j.pop.2017.07.012. PMID 29132530.
- ↑ 5.0 5.1 Schlichtemeier S, Engel A (2016). “Anal fissure”. Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
- ↑ Bope, Edward (2018). Conn’s current therapy 2018. Philadelphia: Elsevier. ISBN 978-0323527699.
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