What is Anal Fissure in Infants and Children?

Anal fissure is one of the most important causes of painful defecation and constipation in children. Or on the contrary, one of the main causes of anal fissure is constipation. Anal fissure is a longitudinal tearing of the rectal mucosa in the form of one or more lines due to trauma in the anus.

Anal fissures are the most common cause of bloody and painful stools in childhood. Most fissures heal spontaneously within a few weeks and are called acute fissures. Fissures that do not heal for up to three weeks are called chronic fissures.

 

What are the Causes of Anal Fissure?

The cause of anal fissures is not fully understood. Generally, stools that are harder than usual cause tears in tissues that are sensitive to trauma as they pass through the anus. Therefore, most children with constipation also have anal fissures. Frequent defecation in diarrhea, the use of some antibiotics and blood medications and interventions to the anus (finger examination, insertion of degrees, etc.) may also cause fissure formation.

Hard stool causes tearing of the mucosa and formation of fissure with mechanical effect. In addition, internal sphincter spasm and muscle spasm also cause ulceration and fissure in the mucosa by disrupting tissue blood supply. Anal fissure is often found in the posterior middle of the anus. Since the blood supply in this area is less, anal fissure develops more easily in the back center of the anus.

Can an anal fissure be a symptom of a serious illness?

Yes, it can, especially Chron's and Ulcerative Colitis diseases, which we call inflammatory bowel disease, should be kept in mind.

What are the Complaints of Anal Fissure Patients?

The complaints we encounter in these patients are in small babies; crying when passing gas and poop and blood on the poop and in the form of a swab on the diaper, in older children, pain-related stool retention and constipation are the main complaints. Deepening tears cause bleeding. In these children, fresh blood is seen in the form of streaks on the stool or as a smear on the toilet paper while cleaning the diaper after defecation.

These children also have excessive rectal itching, which can sometimes be confused with intestinal parasites.

How is Anal Fissure Diagnosed?

The main elements of diagnosis are history and physical examination. On physical examination, a tear can be seen progressing towards the anus, usually at the back of the anus, but can be seen anywhere in infants. In female babies, they are commonly found in the anterior middle part. However, it should be kept in mind that anal fissure cannot always be seen from the outside, and the fissure may also be inside the anus.

Is there a need for additional tests for the diagnosis of anal fissure?

Generally not, but sometimes additional pathology, direct X-ray, ultrasonography and some blood tests and stool parasite tests may be requested for the detection of constipation.

Is Colonoscopy Necessary in Patients with Anal Fissure?

No, it is not necessary, but it is performed in patients with ulcerative colon or Chron's disease.

How is Anal Fissure Treatment Performed in Children?

Some of the anal fissures may heal spontaneously without any treatment.

The main principles of treatment are treatment of constipation and treatment of anal fissure. Treatment of any one of these alone causes prolongation or even failure of the treatment.

For constipation, the diet must first be regulated. The best way to do this is to create a healthy and balanced diet. Whole grain breads, bulgur, legumes, fruits and vegetables, and oilseeds are the best and healthiest sources of dietary fiber. Incorporating these foods into the diet on a regular basis is very effective in increasing the volume and consistency of the stool. In addition, the patient is provided with plenty of water.

On the other hand, patients can use some stool softening medications. Appropriate toilet training is given to older children (For more information, you can read our article titled Constipation).

Painkillers to be applied to the anus and pomades that accelerate cellular healing are also helpful in treatment. In chronic fissures, it has been observed that the anal fissure improves by dissolving the internal anal sphincter spasm with the application of Glyceryl trinitrate cream. Daily application should continue for 6-8 weeks.

In small babies, even applications such as degrees and suppositories, finger examination from the anus (rectal touch) can lead to anal fissure formation. Therefore, these applications should be avoided unless there is a very serious reason (tumor, abscess, etc.), especially in babies under 2 years of age.

Surgical intervention is required in cases that do not improve with medical treatment. Surgical treatments include fissurectomy, anal dilatation and lateral internal sphincterotomy. In cases that do not improve with medical treatment, fissurectomy and constipation treatment together improve 80%. However, the number of patients in the pediatric age group who should be referred to these methods is almost negligible (the number of patients in my 30 years of pediatric surgery career is 1, maybe 2).

What Should Be Considered After Anal Fissure Treatment in Infants and Children?

In order for the fissure to recur, it is important to regulate nutrition and teach toilet training properly, especially in older children.

In addition, after the anal fissure heals, an outward skin protrusion (sentinel pile) may form on the edge of the anus. Especially if there is bleeding, this appearance may be mistakenly identified as “hemorrhoids”. This protrusion may remain for a long time after the fissure heals in some children.

Is Botox Used in Anal Fissure Treatment?

Yes, it can be used in patients with chronic anal fissure, but the need for this application, like surgical procedures, is negligible in children and its effects are temporary.

What are Surgical Procedures in Anal Fissure and How Are They Performed?

As mentioned above, this need is almost negligible in the pediatric age group. For this reason, we do not want to mention it here and worry the parents. You can consult your physician in case of need. However, if we need to mention it by name, the surgical procedure called Sphincterotomy is usually applied.

*** The information given here, the content of the website is organized for the purpose of informing the visitor. No information should be considered as advice by visitors and should not lead to any decision or action. Families related to the subject should have their patient examined by a pediatric surgery specialist, consult with him/her and make a decision by consulting his/her one-on-one information.