Overview
Introduction
A patient with an anal fissure usually describes sharp, tearing pain as stool passes, often followed by lingering anal pain and a small amount of bright red blood on the stool o...
A patient with an anal fissure usually describes sharp, tearing pain as stool passes, often followed by lingering anal pain and a small amount of bright red blood on the stool or toilet paper. Most fissures are posterior midline tears caused or aggravated by hard stool, but rectal bleeding must not automatically be attributed to a fissure. The practical nurse's first clinical question is whether the presentation follows this classic pattern or whether the fissure is atypical. A lateral or multiple lesion, painless bleeding, failure to heal, or associated systemic or infectious features changes the priority from routine symptom care to further medical evaluation. Assessment and teaching should address both sides of the problem: preventing another traumatic bowel movement and recognizing findings that suggest a secondary cause, abscess, fistula, or another source of bleeding.