In order for the doctor could determine if the patient has an anal fissure, he must gently dissolve the buttocks for inspection of the anal canal. Spreading the walls of the anal canal usually reveals an anal fissure. Obese people with well-developed layer of fat in the buttocks to detect anal fissure should be long and gradually raise the edge of the anus.
Sometimes the doctor has to resort to digital rectal examination. In this maneuver, a physician determines the presence of spasm of the anal sphincter. Such a procedure can lead to unnecessary trauma anal fissure, so when it is treated in an outpatient setting is best to postpone the procedure until complete healing of fractures.
In patients with anal fissure does not apply instrumental methods of diagnosis, such as anoscopy or sigmoidoscopy, which is associated with severe pain. If necessary, as such research is conducted anesthesia.
Differential diagnosis of anal fissure
Differential diagnosis of anal fissure does not constitute a hardship. First of all, we should distinguish between anal fissure from incomplete internal fistula of the rectum. The difference between them is the fact that the fistula is usually not marked spasm of the sphincter. In addition, the pain is less. In this case the main feature of fistula - a purulent discharge.
When fistula is possible to make digital rectal examination. The doctor sets out a clear indentation on the bottom of the ulcer - the cavity of the fistula.
Chronic anal fissure is often accompanied by anal itching, inflammation of the rectum - proctitis or proctosigmoiditis.
In anal fissure is important to distinguish it from other manifestations of diseases that can occur is similar: syphiloma, tuberculous ulcer of the rectum, some rare parasitic (actinomycosis) or other diseases, such as anal fissures in Crohn's disease. In this case, it is important to carefully question the patient (to collect a complete medical history) because the clinical course of these diseases are different, as manifested in the form of crack - the same.
