What is the role of anoscopy in the workup of anal fissure?

Updated: Dec 15, 2017
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

The diagnosis of anal fissure can usually be made on the basis of findings from a gentle perianal examination with inspection of the anal mucosa, in conjunction with a good history. In this case, no diagnostic procedures are required. A digital rectal examination (DRE) is painful and often can be deferred.

Occasionally, the fissure is not easily visualized, and anoscopy is required to see it. However, anoscopy is not well tolerated by a patient with an acute anal fissure, and the procedure can often be deferred, with the patient treated solely on the basis of symptoms. Occasionally, a topical application of 1-2% lidocaine facilitates the examination.

Patients who do not heal, those who have relief from symptoms with appropriate therapy, or those who have a recurrent anal fissure after surgical therapy should be evaluated further with anoscopy and rigid proctosigmoidoscopy to exclude other pathologies. Patients with chronic fissures tend to have less pain and can better tolerate either anoscopy or rigid proctosigmoidoscopy and should have this included in their evaluation.


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