Anal Fissure: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdomen
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
      • Anal region / anal canal (examination in lithotomy position; inspection of the anal region and in addition thereby spread the nates / buttocks) [redness?, swelling, nodules?, lobules?, prolapsed tissue?, prallel elastic node perianal (usually pinhead- to plum-sized), bluish-red; at the anal margin or in the anal canal?, blood?; anal fissure? (Location of anal fissure: posterior commissure, i.e., at 6 o’clock in lithotomy position (80 to 90% of cases):
        • Acute anal fissure: ulcer in the anoderm (ulcer in the area of the anal mucosa)?
        • Chronic or chronified anal fissure: hypertrophic anal papilla (distal mucosal extensions of the anal columns)?, outpost fold or guardian mariske (perianal/around the anus localized, flaccid skin folds) distal to the fissure?; ulcer (ulcer) with marginal wall?, fibrosed edges of the ulcer?, possibly visible fibers of the sphincter muscles (muscles of the sphincter)?]
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
    • Digital rectal examination (DRU): examination of the rectum (rectum) [leading symptoms: pain in the anal region (especially during defecation); anal spasm; pruritus (itching) at the anus; pale bloody stool deposits][due todifferential diagnoses:
      • Anal abscess (encapsulated collection of pus located in the anal canal).
      • Anal fistula (abnormal duct connection originating in the anal canal) → clarification of Crohn’s disease required; in approximately 40% of cases, this is the first symptom of the disease
      • Hemorrhoids
      • Crohn’s disease (chronic inflammatory bowel disease; it usually progresses in episodes and can affect the entire digestive tract; characteristic is the segmental affection of the intestinal mucosa (intestinal mucosa), that is, several intestinal segments may be affected, which are separated by healthy sections)]
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.