People with anal fissures almost always experience anal pain that worsens with bowel movements. The pain following a bowel movement may be brief or long lasting; however, the pain usually subsides between bowel movements. The pain can be so severe that patients are unwilling to have a bowel movement, resulting in constipation and even fecal impaction. Moreover, constipation can result in the passage of a larger, harder stool that causes further trauma and makes the fissure worse. Symptoms and signs of anal fissure in TCM include.

1. Syndrome of Blood Heat and Intestinal Dryness
Main Symptoms: One bowel movement every two to three days, constipated stool, pain in the anus in defecation, with blood drops or blood stained on toilet paper, fresh red color in fistula, abdominal distension and fullness, yellowish urine, slightly red tongue, thin and yellowish coating, wiry and rapid pulse.

2. Syndrome of Yin Deficiency and Fluid Loss
Main Symptoms: Constipated stool, one bowel movement several days, pain and bleeding drops in defecation, deep red color in fistula, accompanied by drymouth, dry throat, feverish sensation in the chest, palms and soles, reddened tongue, scanty coating, thready and rapid pulse.

3. Syndrome of Qi Stagnation and Blood Stasis
Main Symptoms: Constipated stool, obvious pricking pain in and after defecation, shrinking anus, purple dark color in fistula, purple dark tongue, thin coating, wiry or hesitant pulse.