Anal Fissure in Children

Abstract

Anal fissure is a common clinical problem in children and is defined as a longitudinal tear in the anal canal. The typical presentation is painful defecation and rectal bleeding. The etiology of anal fissure is unknown, but passage of hard stools and increased internal anal sphincter pressure are considered important factors. The treatment is oriented to relieve the spasm of the internal anal sphincter, which prevents healing of the fissure. Conservative management with stool softeners, topical analgesics, and sitz baths is recommended as first-choice therapy. Surgical treatment has been replaced by nonoperative management as definitive therapy, which is associated with a marginally higher success rate than placebo. Most recent studies have focused on nonoperative treatment with glyceryl trinitrate, calcium channel blockers, or botulinum toxin injection treatment. There are a few controlled studies to compare the different nonoperative treatment options in children. Success rates vary between the studies, and there is no clear evidence about which is the optimal nonoperative treatment. A significant recurrence rate has been reported after nonoperative management of anal fissure. It is important to treat constipation to avoid recurrent tears in the anal canal.

Acquired Ano Rectal Conditions (AARC) in Children Seen at Gezira National Center for Pediatric Surgery (GNCPS-Sudan), Epidemiology, Management, and Outcome

“…In this study, 16.6% of the cases developed complications in wound infection, and recurrent fistula is zero, reflecting the effectiveness of the surgical treatment. Anal fissures are presented in children between 2 to 12 years with a mean age of 7 years; the prior presentation period is two years in several studies 11 . In this study, 55.5% were treated medically with topical anesthetics, laxatives, and diet modification which is generally a promising mode of treatment according to the available literature 12 , but 40% of cases show no improvement on medical options and needed further management.…”

Does the severity of anal fissure trigger constipation?

“…Although anal fissure is a common clinical problem, epidemiologic data on it are limited. [1] It was recognized as a disease for the first time in 1934. Although it can be observed at all ages in childhood, it is observed much more frequently between six and 36 months.…”

“…Anal fissure is a very common clinical problem in childhood. [1] It is usually observed as linear or teardrop-shaped mucosal tears extending from the anal margin to the dentate line. [2] In the period following the formation of anal fissure, the feeling of pain associated with passing stool causes constipation in children.…”

Conservative management of anal fissure accompanying constipation in school-age children

“…In the etiology of anal fissure defecation of hard stools and elevated internal anal sphincter pressure are important factors. Acute anal fissures often heal spontaneously or with simple dietary modification and stoolsoftening laxatives when necessary [1]. Fissures persisting for more than 4 to 6 weeks are often referred to as chronic [2][3][4].…”