Anal Fissure

What is an anal fissure?

An anal fissure is a small tear or crack in the skin at the opening of the anus. More than 90% of children with blood in their stools have an anal fissure.

You may notice the following symptoms:

• The blood in the stool is bright red.
• The blood is only a few streaks or flecks.
• The blood is on the surface of the bowel movement (BM) or on the toilet tissue after wiping.
• Your child usually passes a large or hard bowel movement just before you notice the blood.
• You may see a shallow tear at the opening of the anus when the buttocks are spread apart, usually in a clock position of 6 or 12 o'clock. However, a tear cannot always be seen.
• Pain usually occurs during the passage of a BM.
• Touching the tear may cause mild pain.

What causes an anal fissure?

Constipation or passing a hard or large BM is the usual cause of anal fissures. Rarely it is due to a Strep infection around the anus.

How long does it last?

Bleeding from a fissure stops on its own in a few minutes. Fissures heal quickly, usually in 1 to 2 days.

How can I take care of my child?

• Warm saline baths

  Give your child warm baths for 20 minutes, 3 times a day until the pain stops. Have him sit in a basin or tub of warm water with about 2 ounces of table salt or baking soda added. Don't use any soap on the irritated area. Then gently dry the anal area.

• Stools

  After passage of stools, gently cleanse the anus with warm water. Do not use dry toilet tissue until the fissures are healed.

• Ointments

  If the anus seems irritated, you can apply 1% hydrocortisone ointment (nonprescription). If the pain is severe, apply 2.5% lidocaine (Xylocaine) or pramoxine ointment (nonprescription) a few times to numb the area.

• Diet

  The most important part of treatment is for your child to eat more fiber and drink plenty of fluids to keep from getting constipated. Increase the amounts of fresh fruits and vegetables, beans, and bran products that your child eats. Reduce the amounts of milk products your child eats or drinks.

  A nonprescription stool softener such as mineral oil, MiraLAX, or docusate may be needed for a short time.

When should I call my child's healthcare provider?

Call during office hours if:

• The bleeding increases in amount.
• The bleeding occurs more than 2 times (after treatment begins).
• You have other concerns or questions.