By rray, 11 December, 2014 Exclude Patient Type Detail Header No Detail Type Text Detail Text Hx: pain during/after BMs and BRBPR w/ wiping; pt may describe a “painful hemorrhoid”; anal sphincter spasm Exam: longitudinal fissure; 90% are posterior midline; if lateral, consider Crohn, TB, syphilis, HIV/AIDS, derm conditions (eg, psoriasis), anal CA Chronic features: edema/fibrosis; internal anal sphincter fibers may be seen at base; may typically see skin tag (sentinel pile) distally, hypertrophied anal papilla proximally Patient Type Detail Header (Long) Evaluate and determine fissure position