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Anal fissures in children

December 25, 2021

One of the most common complaints when visiting a pediatric surgeon is blood in the stool. Naturally, this scares the parents, but, fortunately, in the overwhelming majority of cases, in children it is not associated with serious problems. Proctological diseases in children are less common than in adults (if we do not consider congenital malformations, which can manifest themselves throughout life).

The appearance of blood in the stool can be observed in some diseases that affect both the anorectal zone and the gastrointestinal tract in its various parts. One of the most common problems in pediatric outpatient proctology is anal fissure.

An anal fissure (anal fissure) is a defect in the mucous membrane of the anal canal. For the most part, this pathology occurs in preschool age, equally often in boys and girls.

Causes:
As a rule, the main reason for tearing the mucous membrane of the anal canal is the passage of dense feces. However, there are also predisposing reasons – these include diarrhea (diarrhea) of various etiologies, proctitis (inflammation of the rectum) and other conditions that cause swelling of the rectal mucosa, as a result of which its mucosa becomes more vulnerable. Less often, scratching caused by itching in the anus during helminthic invasions, as well as gross mechanical impact (for example, trauma with a hard tip of an enema), can lead to the formation of cracks.

Complaints:
In the presence of this disease in a child, parents most often pay attention to two factors: the child’s strong anxiety when trying to empty himself, up to refusal to land on the potty, and second – the presence of blood in the stool. A fissure in the anus is characterized by the presence of scarlet blood at the end of emptying, or on toilet paper. In children of the first year of life, parents are usually worried about the presence of streaks of blood in the diaper.

Pain in anal fissure is associated with the act of defecation (emptying) and has different severity and duration. Because of the fear of pain, the child suppresses the urge to empty. Stool retention leads to compaction of feces, which in turn contributes to greater trauma to the crack, resulting in a reflex contraction (spasm) of the sphincter. This increases pain and prevents the defect from healing. A vicious circle is created. The child begins to fear the upcoming act of defecation.

Diagnostics:
If blood appears in the stool, a surgeon’s examination is necessary. Examination of the rectum begins with careful dilution of the buttocks and examination of the anus. If anorectal disease is suspected, a digital rectal examination is also necessary.

However, if the anal fissure is obvious, the doctor may postpone the rectal examination until the defect in the anal mucosa heals, so as not to aggravate the pain syndrome in the child. However, you need to understand that the presence of an anal fissure cannot exclude the presence of other diseases of the anorectal region, therefore, a rectal examination is mandatory, even if the defects heal and there are no complaints.

Treatment:
Treatment of anal fissures in children is in most cases conservative and is aimed at normalizing the stool, relieving pain and spasm of the sphincter, as well as healing the fissure itself.

First of all, it is necessary to regulate the drinking regime and diet. Increase your fluid intake. A diet with the inclusion of foods and dishes that enhance motor function and bowel emptying (vegetables, fresh and dried fruits, baked goods made from wholemeal flour, dairy products, etc.) is recommended.

To restore the normal functioning of the intestines, products from yeast and puff pastry, soups in the first broth, sweet soda, pasta, rice, mushrooms, and legumes should be excluded from the diet. From drinks, jelly, cocoa, strong tea should not be allowed on the menu. Bananas, blueberries, dogwood from banned fruits and berries; sweet: chocolate, and custard desserts. Food is cooked mostly not chopped, boiled in water or steamed, baked.

To soften the feces, vaseline oil, flax seeds are prescribed inside.

However, in addition to observing food and drinking regimes, local treatment is very important – daily cleansing enemas are required, followed by sessile baths with a slightly pink solution of potassium permanganate or chamomile, healing suppositories, and the use of healing ointments. Local treatment should be prescribed by a physician.

The prognosis of this disease in children, as a rule, is favorable with the timely and full implementation of the doctor’s recommendations. In exceptional cases, the process can take on a chronic form and require invasive methods of treatment, which is usually typical for adolescent children.

It is important for parents to understand that the discharge of blood from the anus can have a variety of reasons, not always associated with proctological diseases. That is why you should not self-medicate, you need to consult a doctor at the first signs of the disease in order to get recommendations on time for both examination and treatment.