A 35-Year-Old Man Comes to the Office Due to a 1-Week

A 35-year-old man comes to the office due to a 1-week history of excruciating pain during defecation.  The pain is so severe that he avoids defecating.  The caliber of the patient's stool has not changed, but he has had visible bright red blood on the surface of the stool.  His medical history is significant for chronic constipation.  The patient is taking no medications and does not use tobacco, alcohol, or illicit drugs.  Vital signs are normal.  On examination, the abdomen is soft with normal bowel sounds.  Rectal examination shows a posterior mucosal tear of the anus and a skin tag.  In addition to stool softeners and sitz baths, which of the following is the most appropriate next step in management?

A) Colonoscopy and random mucosal biopsies
B) Excision and closure of the fissure
C) Gradual dilation of the sphincter
D) Lateral sphincterotomy
E) Topical lidocaine and nifedipine

Correct Answer:

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