Snapshot A 45-year-old man has severe rectal pain when he defecates. He reports the stool is covered with bright red blood. A sentinel pile is noted on physical exam. Introduction Tear or fissure in anal epithelium Can occur at any age Caused by login to view 3 more bullets Leads to tightening of anal canal related to nervous tension Presentation Symptoms login to view 3 more bullets Evaluation Anoscopy login to view 2 more bullets Treatment Medical login to view 2 more bullets Surgical login to view 1 more bullet