An anal fissure is a tear in the tissue around the bottom, the puckered ring where stool leaves the rectum. This area tears easily when a child is constipated and has a large, hard stool. Small cuts in the skin around the anus result in bright red spots of blood. If your child is in diapers, you will see blood in the diaper next to the stool, or the blood will be visible when you use wipes. If your child is potty trained, the toilet water may look red, or there may be blood on the toilet paper. In either case, with anal fissure blood is never actually mixed into the stool.
Anal fissures hurt because (1) it hurts to tear the skin around the anus, (2) it stings when stool or urine come into contact with the tear or when the injured skin is wiped clean, and (3) the anus spasms as a result of the fissure, and these spasms are uncomfortable. Although the skin heals relatively quickly, every time another sizable stool comes along, it can reinjure the broken skin. For this reason, a toddler with an anal fissure may try to avoid pooping. This creates a vicious cycle because the child will hold in his stool and become increasingly constipated. When he finally does poop, he will be significantly more likely to retear his anus.
Stools must be soft in order not to tear the irritated skin, but for the stools to be soft, the child must be willing to pass them with relative frequency.
What can I do?
If you are not sure whether your child has an anal fissure, you can shine a flashlight onto his bottom and look for a small, slitlike tear just inside the ring of anal tissue. Sometimes the area will be slightly red, or there will be a spot of dried blood at the site.
To help relieve the stinging, put a small amount of a color-free, perfume-free lubricant, such as petroleum jelly (Vaseline), around the anus. This will lubricate the skin so that the next time your child poops, the stool can pass more easily through the anus. Apply the lubricant using your pinkie finger, not a Q-Tip or other narrow tool. You can repeat this every few hours or with each diaper change until a stool is passed without tearing the skin.
To minimize pain with wiping, avoid perfumed wipes, which will sting when they come into contact with the tear.
If your child is constipated, it is critical that you address that issue, because chronically hard stools will continuously retear the skin.
When does my doctor need to be involved?
If you are not sure whether an anal fissure is the source of your child’s bleeding, you should call your doctor. You should also call if the bleeding amounts to more than a few drops of blood, if it increases, if it persists, or if the blood is mixed into the stool. Anytime you are unsure, ask your doctor.
What tests need to be done, and what do the results mean?
Anal fissures do not require any tests. But if the blood is mixed into the stool rather than coating it or sitting beside it, the source of bleeding is likely somewhere inside the intestine rather than an anal fissure. If intestinal bleeding is suspected, a stool sample should be tested for infection, inflammation, and other causes of intestinal bleeding.
What are the treatments?
The primary treatment for an anal fissure is lubrication of the us to help the stool slide through more easily. Sitz baths are also helpful. These warm-water baths contain various mild agents that help soothe the skin. Remember, if your child’s constipation is the underlying cause of the fissure, the constipation must be treated. Stool softeners are very effective.
What are the possible complications?
A chronic fissure is one that will not heal. Such a fissure can develop when the same tear is continually reopened before it has time to heal. Fissures can also bleed excessively or become infected. All of these complications are extraordinarily uncommon.