anal fissure

Anal fissure is a small tear of the junction of the internal mucous membrane of the bowel with the external skin of the anus. It is caused by the forceful passage of a hard stool, and is mainly seen in infancy.

Children can get into a viscious cycle:

  • passage of a large, hard stool produces a tear
  • the child withholds the stool to avoid painful defecation
  • the withheld stool gets even harder and bulkier
  • stool passage becomes even more traumatic, leading to more stool withholding

Parents might note a little skin "tag" next to the tear, that represents healing tissue, secondary to the chronic inflammation.

Treatment involves:

  • helping the parents to understand how the tear happens and especially the mechanism of the cycle of constipation
  • working to see that the child has only soft stools to avoid overstretching the anus.
  • allowing the healing process to occur, which may take several days or even several weeks
  • a stool softener is indicated, but the parents will need to adjust the dose to keep the child's stools neither too hard or too loose

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