When examining patients with anal fissure, be sure to let the patient relax the anus and actively cooperate. First, use the second-hand thumb to gently scrape the skin of the anal margin to both sides, that is, a vertical oval shape can be seen from the lower edge of the tooth line to the anal skin Ulcers, acute anal fissures are red in color, have shallow bottoms, and have soft edges. Chronic anal fissures have irregular edges and hard textures due to long-term chronic inflammation. There are often connective tissue hyperplasia, and the bottom is dark and gray. If all or part of the ulcer is seen during inspection, the diagnosis of anal fissure can be made. Some patients with chronic anal fissure can see the skin tag on the lower edge of the anal orifice ulcer, the so-called "sentinel hemorrhoids" standing like a sentinel, which means that the anal fissure is just below it, making the diagnosis easier. It is worth noting that the anal sphincter of patients with anal fissure is often in a state of spasm. Digital rectal examination or anoscopy can cause pain, and some even severe pain. Therefore, if the diagnosis is confirmed, there is no need for routine digital examination. So as not to increase the patient's pain. Of course, there are some less typical patients with anal fissure who feel less or no pain, so you can tentatively do digital examination and further anoscopy. For example, if the pain of anal fissure is severe, but there is a suspected rectal tumor, cotton swabs can be used. Do digital examination after applying surface anesthetic.
------Excerpt from Li Shenglong and Yin Tingbao's "Secret of Hemorrhoids" published by Guangdong Economic Publishing House in October 2005