Clinical presentation of chronic anal fissures.

Chronic anal fissures have a varied and often confusing clinical presentation. To clarify this picture, we retrospectively studied 172 patients to determine associations between patient characteristics and manifestations of these lesions. We found that anterior fissures and sentinel piles were significantly more common in women; pruritus and rectal drainage occurred significantly more often in men; and patients with a longer duration of symptoms and those with pruritus and drainage were more likely to have a fistula. Younger patients were more likely to report rectal bleeding. Patients with chronic anal pruritus or an anal abscess should be carefully evaluated for an anal fistula, since anorectal problems may recur if a fistula remains untreated.