Approach
• Nature: Duration, consistency of stools, bleeding, fevers
Anal Fissure
Definition: Superficial tear of the anoderm that begins just below the dentate line
History: H/o passage of hard stools, sharp pain w/ defecation, blood on toilet paper
Physical Findings: Visible fissure, painful. If not midline, eval for cancer, HIV, IBD, STDs.
Management: Sitz baths (warm baths 15 min 3×/d), high-fiber diet, lidocaine jelly