Abstract
Answer B. Anal fissure
The history is typical of anal fissure. The patient has sharp, localised pain with rectal bleeding. He can recall a particular episode of pain when the tear occurred. Anal fissure is usually caused by constipation and straining. It may be confirmed on examination. An abscess presents with a painful swelling and a fistula usually follows a previous perianal abscess and presents with discharge from an external opening. Haemorrhoids can also present with pain and bleeding accompanied by perianal itch but symptoms are intermittent. This patient is young and has a 1-week history of sharp rectal pain associated with rectal bleeding. It is recommended that patients under age 50 years with rectal bleeding and abdominal pain or a change in bowel habit, weight loss or iron-deficiency anaemia are referred under a suspected cancer pathway.
InnovAiT article: Benign ano-rectal disorders. DOI: