A watchful history generally suggests that an anal fissure is there, and gentle examination of the anus can confirm the presence of a fissure. If moderate eversion (pulling apart) the edges of the anus by separating the buttocks does not expose a fissure, a more vigorous inspection following the application of a topical anesthetic to the anus and anal canal may be required. A cotton-tipped swab may be inserted into the anus to gently localize the source of the pain.
Your doctor will perform a digital rectal exam, which involves inserting a gloved finger into your anal canal, or use a short, lighted tube (anoscope) to inspect your anal canal. However, if this procedure is too painful for you, it is done under local anesthesia.
An acute anal fissure seems like a fresh tear, rather like a paper cut. A chronic anal fissure likely has the tear, as well as two separate lumps of skin, one inner (sentinel pile) and one outer (hypertrophied papilla).
The fissure’s location gives clues about its cause. A fissure that develops on the side of the anal opening is more likely to be a sign of any other disorder, like Crohn’s disease. Your doctor may advise further testing if he or she thinks you have any underlying condition:
Your doctor will put in a thin, flexible tube with a small video into the bottom portion of your colon. This test is done if you’re younger than 50 and have no risk factors for intestinal ailments or colon cancer.
Your doctor will put in a flexible tube into your rectum to examine the entire colon. This test is done if you are older than 50 yrs or you have risk factors for colon cancer or other symptoms like abdominal pain or diarrhea.