Your doctor will likely ask about your medical history and perform a physical exam, including inspection of the anal region. Often the tear is visible. Usually this exam is all that's needed to diagnose an anal fissure.
Your doctor will probably refrain from performing a digital rectal exam, which involves inserting a gloved finger into your anal canal, because it is likely to be too painful. If anal fissure is suspected but can't be identified, your doctor may use a short, lighted tube (anoscope) to inspect your anal canal.
The fissure's location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn's disease. If an underlying condition is suspected, your doctor may recommend further testing:
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- Flexible sigmoidoscopy. A thin, flexible tube with a tiny video camera is inserted into the bottom portion of your colon. This test may be done if you're younger than 50 and have no risk factors for intestinal diseases or colon cancer.
- Colonoscopy. A flexible tube is inserted into your rectum to inspect the entire colon. This test may be done if you are older than age 50 or have risk factors for colon cancer, signs of other conditions, or other symptoms such as abdominal pain or diarrhea.
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Oct. 16, 2012.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-1-4377-1604-7..C2009-0-42832-0--TOP&isbn=978-1-4377-1604-7&uniqId=327451096-2. Accessed Oct. 16, 2012.
- Anal fissure. U.S. National Library of Medicine. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002116/. Accessed Oct. 17, 2012.
- Anal fissure. American Society of Colon & Rectal Surgeons. http://www.fascrs.org/patients/conditions/anal_fissure. Accessed Oct. 17, 2010.
- Zaghiyan KN, et al. Anal fissure. Clinics in Colon and Rectal Surgery. 2011;24(1):22.
- Etzioni DA. Current management of anal fissure. Seminars in Colon & Rectal Surgery. 2011;22:2.