Anal fissure is common and painful; it is a longitudinal tear in the sensitive squamous mucosa of the lower half of the anal canal. In men over 90% are in the midline posteriorly; in younger women about 30% are anterior. Pain and bleeding during and after the passage of stool are the usual presenting features. An acute fissure is superficial and is not associated with a skin tag or secondary infection; there has been no time for fibrous tissue to form. A chronic fissure is usually deep and indurated, with local infection; it is almost always associated with an oedematous skin tag and a fibrous anal polyp at the inner end of the fissure.
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