Anal fissure staging is often dichotomous, trichotomous, or quintuplet.
1.Dichotomous method
(1) Acute and chronic classification method
Acute anal fissure: refers to a fresh fissure of the skin of the anal canal without papillary hypertrophy and sentinel hemorrhoids.
Chronic anal fissure: refers to old fissures of the anal canal, which form ulcers after repeated infections, combined with hard nodules at the trauma edge, papillary hypertrophy and sentinel hemorrhoids, etc.
(2) Early and late classification method
Early anal fissure: the fissure is fresh, chronic ulcer has not yet formed, and the pain is mild.
Old anal fissure: the fissure is already in the shape of a pike ulcer, and there are also sentinel hemorrhoids, anal sinusitis or anal papillary hypertrophy, and there is periodic pain.
2.Five-point method
It is mostly adopted by foreign scholars.
(1) Stenosis type: the internal sphincter is in spasm, the anal canal is tense and narrow, and there is typical periodic pain, and this type accounts for more than 70% of anal fissures.
(2) Prolapsed type: Anal fissure caused by prolapsed and inflamed internal and external hemorrhoids. The pain is mild and there is no obvious narrowing of the anal canal.
(3) Mixed type: Anal fissures caused by a mixture of stenosis and prolapse.
(4) Fragile type: superficial ulcers caused by eczema and dermatitis of the anal canal skin.
(5) Syndromic: syndromic anal fissures such as Crohn’s disease, ulcerative colitis, anal canal tuberculosis, syphilis, etc. Fissures with delayed healing of postoperative trauma of the anal canal also belong to this.
3.Three points method
The three-division method is a common clinical division method, which is simple, practical and clear.
Stage I anal fissure: also called primary anal fissure, i.e. fresh anal fissure or early anal fissure. The skin of the anal canal is superficially damaged, and the tissue around the wound is basically normal.
Stage II anal fissure: also known as simple anal fissure. The anal canal has formed ulcerative fissures, but there are no comorbidities, no anal papillary hypertrophy, sentinel hemorrhoids and subcutaneous fistulae, etc.
Stage III anal fissure: This refers to old anal fissures and generally refers to anal fissure triad, but also includes references such as quadruple or quintuple fissures. The fissure is characterized by old ulcers, combined with anal papillary hypertrophy and sentinel hemorrhoids, or with subcutaneous fistula and inflammation of the anal fossa.