Anal Fissures

A small tear or cracklike sore in the mucous lining of the anus, the outlet through which fecal waste passes, is known as an anal fissure. Fissures are the most common cause of rectal bleeding in infants and older children. While parents may be alarmed to see a blood stain in their child's stool or diaper, there is usually no need for concern. Anal fissures can be treated successfully and seldom become chronic.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS ANAL FISSURES?
If you see blood in your child's stools or diaper, anal fissures are a possible cause. Your child also may be constipated, refuse to defecate or complain of pain when moving the bowels.

WHAT CAUSES ANAL FISSURES?
Anal fissures ususally are caused by constipation. They develop when stools are dry and hardened and moving the bowels requires exertion. As the child strains, the anus stretches and the mucous lining cracks like a split lip. The passing stools irritate the wound and cause the surrounding muscles (the sphincter muscles) to go into spasms. Spasms are painful and can delay healing by leading to increased constipation.

HOW CAN THE DOCTOR TELL IF MY CHILD HAS ANAL FISSURES?
Your doctor can usually see the fissure by examining the exterior of the anus. In rare cases, a special viewing instrument called a proctoscope may be needed to inspect the inside of the anus and rectum.

IS MEDICAL ATTENTION NECESSARY?
Yes. Although most anal fissures heal naturally or respond quickly to simple treatments, the pediatrician should be consulted. If constipation is the cause of the fissure, establishing a more regular bowel pattern should promote healing. Stool softeners, glycerin suppositories or psyllium-containing powders will relieve constipation, but a change in diet may be necessary over the long term.

To speed the healing, the doctor may prescribe a hydrocortisone cream or ointment to the crack. Warm baths will soften the skin and may aid in healing.

PREVENTING ANAL FISSURES

• Add fiber to the child's diet and encourage fluids to prevent constipation.

• Make sure the rectal area is clean after bowel movements.

• Encourage the development of regular bowel movements.

GETTING HELP
Call your doctor if any of the following occur:

• Your child is regularly or severely constipated

• Your child has blood in the stool on several occasions

• Your child complains of pain during or after bowel movements

• Your child refuses to defecate

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.