On inspection the anal fissure is usually seen in the anal margin, situated in the midline posteriorly (6 o'clock). The fissure appears as an elliptical ulcer involving the lower third of the anus from the dentate line to the anal verge. 1

Digital examination and sigmoidoscopy are difficult because of painful anal sphincter spasm.

If there are multiple fissures Crohn's disease should be suspected. These fissures look different, being indurated, oedematous and bluish in colour.

In chronic anal fissures a sentinel pile is common and in long-standing cases a subcutaneous fistula is seen at the anal margin, with fibrosis and anal stenosis. 1

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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