By rray, 11 December, 2014 Exam: longitudinal fissure; 90% are posterior midline; if lateral, consider Crohn, TB, syphilis, HIV/AIDS, derm conditions (eg, psoriasis), anal CA
By rray, 11 December, 2014 Hx: pain during/after BMs and BRBPR w/ wiping; pt may describe a “painful hemorrhoid”; anal sphincter spasm
By rray, 11 December, 2014 If no response to conservative pharmacologic tx refer for surgery or injection tx