What is the anal disorder that best describes her symptoms?
A 36-year-old married bank teller comes to your office, complaining of pain with defecation and occasional blood on the toilet paper. She states that last week she had food poisoning with nausea, vomiting, and diarrhea. She had runny stools but no black or bloody stools. Ever since her illness, she has continued to have severe pain with bowel movements. She now tries to put off defecation as long as possible. Although she is having constipation she denies any further diarrhea or leakage of stool. She has a past medical history of hypothyroidism and two spontaneous vaginal deliveries. She has had no other chronic illnesses or surgeries. She does not smoke and rarely drinks. She has two children. There is no family history of breast or colon cancer. She has had no weight gain, weight loss, fever, or night sweats. On examination she is afebrile, with a blood pressure of 115/70 and a pulse of 80. On abdominal examination she has active bowel sounds, is nontender in all quadrants, and has no hepatosplenomegaly. Inspection of the anus reveals inflammation on the posterior side with erythema. Digital rectal examination is painful for the patient but no abnormalities are palpated. Anoscopic examination reveals no inflammation or bleeding.
A) Anorectal fistula
B) External hemorrhoids
C) Anal fissure
D) Anorectal cancer
C) Anal fissure
Anal fissures often occur after severe diarrhea or constipation. They cause bright blood on the toilet paper and are extremely painful during defecation. A small ulceration or fissure is observed proximal to the anus.
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