Anal fissure in children

Question 1

Define Anal fissure

Answer 1

Tear or ulcer in the lining of the anal canal causing pain on defecation

Question 2

Causes of Anal fissure

Answer 2

Primary - no cause

Secondary - Constipation is leading cause in children
Hard stools

IBD-especially crohns
STI’s

if none of those-consider anal abuse

Question 3

Signs and Sx of anal fissure in children

Answer 3

Painful defecation
Blood -bright red on tissue

can examine back passage but be careful with children

Question 4

Ix of anal fissure in children

Answer 4

Clinical diagnosis but can Investigate IBD, Constiption with Xray

Question 5

Mangement of anal fissure in children

Answer 5

Most common cause-diet/hard stools/constipation

Conservative-
encourage - fiber, fluid intake
Analgesia for the pain - ibuprofen, paracetamol
Sit in shallow warm bath
advice against stool holding

Constipation pathway - lactulose and macrogol