If there is pain in the anus during and after defecation with fresh blood and formed or dry stools, the first thing to consider is anal fissure. Recurrent anal fissures may present with swelling at the anal opening, prolapsed anal swelling, perianal dampness, discharge and itching, which are complications of anal fissures such as sentinel hemorrhoids, anal papillomegaly or subcutaneous fistula. Anal fissures are small ulcers in the skin layer of the anal canal, usually with severe pain and bleeding, and are more difficult to heal, occurring in the anterior and posterior areas of the anus. Anal fissures need to be distinguished from skin chaps caused by anal pruritus, which occur mostly on the surface of the perianal skin in a radial pattern with superficial fissures.