Anal Fissure in Children

• Published in: Nippon Daicho Komonbyo Gakkai Zasshi Vol. 58; no. 10; pp. 853 - 856
• Main Authors: Fujita, M., Kusakawa, I., Matsufuji, H., Nakamura, A., Araki, Y.
• Format: Journal Article
• Language: English
• Published: The Japan Society of Coloproctology 2005
• ISSN: 0047-1801; 1882-9619; 1882-9619
• DOI: 10.3862/jcoloproctology.58.853

Anal fissures are usually associated with bleeding and intense perianal pain during passage of stool. Superficial acute tears are common in infancy and are the most common cause of bright red blood per rectum in children. Fissures are most common in infants between two and four years of age and are located in the posterior and anterior midline just below the dentate line. It is an acquired lesion secondary to the forceful passage of a hard stool. Usually, a history of constipation is elicited ; the patient retains stool voluntarily to avoid a painful bowel movement. This exacerbates the constipation and eventually, the passage of the hard stools creates a vicious cycle. Unhealed fissures may become infected and evolve into chronic ulcer associ-ated with the sentinel tag and hypertrophied anal papilla. The diagnosis is established by inspection of the anal area. The most important element in the treatment of this condition is for the parents to understand the origin of the laceration and the mechanism of the cycle of constipation. A stool softener is indicated but the parents must adjust the dose according to the response of the patient. The majority of children with fis-sures will be cured and have relief of symptoms, and surgical procedures are rarely indicated. Fissures in newborn babies or intractable chronic fissures in older children may be associated with congenital anal anomalies or inflammatory bowel disease.