Exams and Tests
Your doctor can diagnose an anal fissure from your symptoms and a physical examination. The examination may include:
- Looking at the fissure by gently separating the buttocks.
- Digital rectal exam. The doctor uses a gloved finger to feel structures in the anal canal.
- Anoscopy. This exam involves using a short, lighted scope to look into the anal canal.
A doctor usually will wait until the fissure has begun healing before doing a digital rectal exam or anoscopy. If an exam needs to be done immediately, a topical anesthetic can be used to numb the area.
The location of a fissure is important in the diagnosis. If you have more than one fissure or have a fissure on the side of the anus (rather than at the top or the bottom), you may have another condition that is causing fissures. Possible conditions include inflammatory bowel disease (IBD), anal cancer, syphilis, tuberculosis, a suppressed immune system, or HIV infection.
A doctor may look for a small piece of loose skin (a skin tag) in the anus, often a sign of a long-term (chronic) fissure. Skin tags are often mistakenly identified as hemorrhoids.