Anal Fissure Flashcards
What is an anal fissure?
Tear in the skin around the anus, usually a side effect of constipation
Clinical features of anal fissure?
Painful passing of stool
Bright ted blood on tissue
How to manage anal fissure in a child?
- Making stool easy to pass?
Increase fluids and fibre
Lactulose ( or macrogol )
Stool softener
How to manage anal fissure in a child?
- analgesia?
GTN intra-anally (relaxes)
Topical diltiazem (relaxes)
How to safety net anal fissure?
If not healed after 2 weeks or child remains in pain, seek help.
What is the aetiology of most paeds constipation?
Idiopathic/functional (95%)
What are the secondary causes of constipation in paeds?
CHIASMIC
C : Cystic fibrosis
H : Hirschsprung
I : Intestinal obstruction
A : Anal stenosis
S : sexual abuse
M : Milk
I : inactive thyroid
C : cord lesion
What lifestyle factors can lead to constipation?
Low fibre
poor fluid
sedentary
stress
Clinical features of constipation in a child?
<3 stools / week
Hard, hard to pass
Rabbit dropping
Abdo pain
Retentive posturing
Overflow diarrhoeaW
What are the red flag symptoms which warrant referral for constipation?
- Failure to pass meconium
- Failure to thrive
- Abdominal distension
- Lower limb weakness
- ribbon stool pattern (stenosis)
What does ribbon stool mass indicate?
Anal stenosis
What does a ballotable mass on abdo exam indicate?
Kidney mass not faecal impaction
referral
How to manage a child with constipation:
- Diet and lifestyle?
fluid and fibre intake (drink more water, eat more fruit + veg)
exercise more.
(NICE = DO NOT USE DIETARY INTERVENTIONS ALONE AS FIRST LINE)
How to manage a child with constipation:
- Behavioural intervention?
Scheduling toileting
reward system
How to manage a child with constipation:
- with faecal impaction present?
Disimpactation regime:
- Osmotic laxative with escalating dose over 2 weeks
Add senna if no improbement
What osmotic laxatives can be given for a child?
Movicol = polyethylene glycol + electrolytes
How to manage a child with constipation:
- no faecal impaction but conservative measures not working
osmotic laxative (movicol), reduce dose gradually once normal bowel routine established.
