ABSTRACT
Acute anal fissures are generally limited to the mucosa, while chronic anal fissures may extend into the submucosa and expose the internal anal sphincter (IAS). Chronic anal fissures may develop into anal ulcers and are usually associated with a sentinel pile, or skin tag. Anal fissures are the result of high-pressure dilation of the anal canal and are usually associated with severe constipation, the passage of a large hard stool, or repeated episodes of diarrhea. The clinical history is the cornerstone of accurate diagnosis of anal fissures. Patients presenting with an acute anal fissure will complain of a tearing pain upon defecation associated with spots of fresh red blood. Anal malignancy usually presents with a deep-seated pain with an associated mass that has been present for some length of time. The calcium-channel blockers, diltiazem and nifedipine, have been used topically to relax the IAS in hopes of healing and relieving the pain associated with anal fissure.
