Which condition is indicated by a chronic fissure persisting for over 6 weeks?

A chronic anal fissure is characterized by a fissure that persists for more than 6 weeks. This condition often results from prolonged trauma to the anal canal, typically due to passage of hard stools. The tissue surrounding a chronic fissure tends to show signs of fibrosis and may become indurated, which differentiates it from an acute anal fissure that is typically a recent onset and usually heals within a few weeks with appropriate treatment.

Chronic anal fissures may also present with symptoms such as severe pain during bowel movements, bleeding, and often a noticeable skin tag or sentinel pile at the fissure site. The persistence of a fissure beyond 6 weeks indicates that the underlying issues, such as sphincter spasm or inadequate blood supply to the surrounding tissues, are preventing the fissure from healing. This understanding is critical in differentiating chronic fissures from other possible conditions affecting the anal region like rectal prolapse and hemorrhoids, which have different etiologies and management strategies.