title: Anorectal fissures: an under-recognized cause of low back pain? Case report.
abstract: BACKGROUND
  Low back pain is one of the most common complaints for which patients seek medical attention. The differential for such a complaint is wide and therefore requires a thoughtful and thorough work-up. Anorectal disorders are an often-overlooked cause of low back pain.
  
  
  METHODS
  We discuss the case of a 46-year-old male with history of dull aching back pain in the midline at the lumbosacral junction. The pain extended to the left of midline, into the region of the sacroiliac joint. There was no radiation into the buttock or leg. Physical exam was unremarkable. Upon soliciting further history, the patient reported a long history of anal pruritus and occasional hematochezia. Colonoscopy subsequently revealed anal fissures in various stages of healing. He was treated with Metamucil capsules and oral nifedipine with significant improvement of his symptoms.
  
  
  CONCLUSIONS
  Low back pain is a challenging chief complaint to the primary care diagnostician due to its wide differential. In a careful and thorough work-up of this complaint, disorders of the anus and rectum should not be overlooked as possible culprits.
authors.affiliation: College of Medicine, University of Oklahoma, Oklahoma City, USA.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kimmell
authors.forename: Jason
authors.initials: J
authors.lastname: Lees
authors.forename: Mason B
authors.initials: MB
authors.lastname: Andrews
authors.forename: Craig H
authors.initials: CH
authors.lastname: Rabb
mesh_terms: D000284:Administration, Oral; D002400:Cathartics / Q000008:administration & dosage / Q000627:therapeutic use; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005401:Fissure in Ano / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use; D011620:Psyllium / Q000008:administration & dosage / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D002400:Cathartics; D014665:Vasodilator Agents; D011620:Psyllium; D009543:Nifedipine