Snapshot A 33-year-old woman with irritable bowel syndrome (constipation type) presents to her primary care physician for evaluation of severely painful bowel movements. She reports that onset occurs during the bowel movement and may persist for hours afterward causing significant fear of having bowel movements. She also notes small amounts of bright red blood on the toilet paper. Introduction Clinical definition login to view 2 more bullets Associated conditions login to view 4 more bullets Epidemiology Demographics login to view 2 more bullets Risk factors login to view 5 more bullets ETIOLOGY Pathogenesis login to view 3 more bullets Presentation Symptoms login to view 2 more bullets Physical exam login to view 3 more bullets IMAGING Anoscopy or proctosigmoidoscopy login to view 2 more bullets STUDIES Diagnostic testing login to view 10 more bullets Differential External hemorrhoid login to view 2 more bullets Anal cancer login to view 3 more bullets Treatment First-line login to view 8 more bullets Second-line login to view 4 more bullets Complications Chronic anal fissure Fecal bacterial infection of wound