Anal fissure in a child

Question 1

What is an anal fissure? What is the most common location for an anal fissure?

Answer 1

An anal fissure is a tear or ulcer in the lining of the anal canal, immediately within the anal margin.

Majority are posterior

Question 2

What are 3 main causes of anal fissures in a child?

Answer 2

Constipation - passage of hard stools

Crohn’s - if there are multiple , refractory to treatment

Suspect sexual abuse

Question 3

What is the clinical presentation of an anal fissure?

Answer 3

Clinical features of anal fissure include bleeding and persistent pain on defecation, and a linear split in the anal mucosa

Question 4

What is the management of an anal fissure?

Answer 4

Osmotic laxatives, such as lactulose or macrogols (macrogol 3350 with potassium chloride, sodium bicarbonate and sodium chloride)

Simple analgesic (such as paracetamol or ibuprofen, may be offered for prolonged burning pain following defecation.

Refer to specialist if not resolved within 2 weeks.