Overview
Clinical Pattern
Sharp pain that starts with defecation and lingers afterward, paired with a small amount of bright red blood, is the pattern that should make an anal fissure rise on the differe...
Sharp pain that starts with defecation and lingers afterward, paired with a small amount of bright-red blood, is the pattern that should make an anal fissure rise on the differential. The practical nurse must then sort a typical posterior-midline fissure from a lesion that is lateral, multiple, painless, recurrent, or slow to heal; the second pattern may signal Crohn disease, infection, or malignancy. Treatment has a clear physiologic target: soften stool, reduce internal anal sphincter spasm, and prevent pain-driven stool withholding while checking for bleeding, infection, and medication hazards.