An anal fissure is a superficial tear in the anus skin. It results in painful stooling, and blood on the stools, on wiping or in the nappy.
How does an anal fissure develop?
These tears arise often after an episode of constipation. Passing a large hard stool initially stretches the anus skin margin. This stretches the skin creating a little tear. As subsequent hard or large stools pass, they are painful to do. Your child may then, understandably, start withholding. This involves behaviours that try to avoid that the pain associated with passing stools. This worsens the constipation and sets up a vicious cycle of stooling and tearing.
What does an anal fissure look like?
The tears typically appear along the midline. Imagine the anus is a clock-face. Lying down, the genitals mark 12 o’clock and the back mark’s 6 o’clock. These tears appear at 12 and 6 o’clock.
What can be done to treat anal fissures?
It can take several weeks to treat an anal fissure. The key thing to do is to break the cycle of hard/ large stools and tearing. So, although your baby or child may not seem to be constipated (passing infrequent stools), it is important to ensure they are passing soft stools for a few weeks. This allows the fissure area to heal.
The Bristol stool chart is a useful tool for rating stool consistency.
When your child has an anal fissure, aim for stools that are type 4 and above.
This should be done primarily with adequate fluid intake and a diet high in fibre. If further softening is required, stool softening laxatives can be considered. For more information, read about Diet and Constipation.
What about applying a cream?
There are different creams that your doctor will consider.
Soothing creams e.g. scheriproct contain some local anaesthetic and some steroid. It may not be suitable for all babies and children and must be prescribed.
Vasodilator creams work by increasing blood supply to the area. This include diltiazem and GTN. However, these are only prescribed after careful consideration with your surgeon. There may be side effects to think about, particularly if treatment requires several weeks.
Are there surgeries for anal fissure?
Yes. Your surgeon may recommend botox therapy to the anal sphincter. This treatment also has side effects to consider e.g. incontinence, recurrence.
You may have read about other, more radical surgical treatments e.g. fissurectomy, spincterotomy. These treatments are described for adult patients.