Pain occurs with sitting, moving, defecating, and even coughing. Pain usually is throbbing in quality and is constant throughout the day. Place patient in left lateral decubitus position with knees drawn up toward chest. Examine patients carefully to avoid infliction of further pain or sphincter spasm. Examination may be facilitated by application of a topical anesthetic.
Most fissures are visible externally when patient bears down as if having a bowel movement.
Note depth of fissure and its orientation to the midline. Majority of tears are found in the posterior midline. Rectal examinations generally are not tolerated because of sphincter spasm and pain. Acute fissures are erythematous and bleed easily. With chronic fissures, classic fissure triad may be seen.