The causes of anal fissures in children are related to the following factors.
1.Anatomical factors
The shallow part of the external sphincter of the child’s anal canal forms the anal caudal ligament at the back of the anus, which is harder and less stretchable, and the back of the anus is under greater pressure and is easily damaged, forming anal fissures.
2.Trauma
Some children have constipation, due to dry and hard stool, excessive force when defecating, easy to damage the skin of the anal canal, repeated injury so that the fissure deep to the whole skin, the formation of chronic infected ulcers. Constipation causes 14% to 24% of anal fissures, but constipation may also be a consequence of anal fissures, due to the child’s painful bowel movements and fear of defecation.
3. Infection
If a child suffers from some other anal canal disease, such as sinusitis, the affected area spreads downward and causes a subcutaneous abscess that breaks down and becomes a chronic ulcer, which is also a cause of anal fissure. Anal fissures can also be classified as acute or chronic. Acute anal fissures have a shorter duration, are red in color, have a shallow base, and have fresh, neat fissures with no scar formation. Chronic anal fissures have a longer duration, with recurrent attacks, deep uneven bases, often with hypertrophic papillae at the upper end and sentinel hemorrhoids at the lower end, generally known as the “anal fissure triad”. The anterior sentinel hemorrhoid is caused by lymphatic stasis under the skin and resembles an external hemorrhoid. In advanced stages, it can also be complicated by perianal abscesses and subcutaneous fistulas. Parents need to find out what is causing their child’s anal fissure in order to prescribe the right medicine and find the best treatment.
Symptoms of anal fissures
There are three typical clinical manifestations of anal fissures in children: pain, constipation, and blood in the stool.
1. Pain
Anal fissures can cause periodic pain due to fecal discharge, which is the main symptom of anal fissures. When defecating, the nerve endings of the ulcer surface are stimulated by the fecal mass and the anus feels burning pain immediately, but the pain is relieved a few minutes after defecation, which is called the intermittent pain period. Later, due to the spasm of the internal sphincter, severe pain is produced again, and this period can last for half to several hours, and the child is restless and hard to bear until the sphincter is fatigued, the muscle relaxes, and the pain is relieved. However, when defecating again, pain occurs again. The above is clinically known as the anal fissure pain cycle. The pain may also radiate to the perineum, buttocks, inner thighs or sacrococcygeal region. The child may resist defecation and even cry because of the pain.
2. Constipation
Children are reluctant to defecate because of anal pain, which in time causes constipation and drier stools, which in turn can aggravate the fissure, forming a vicious circle.
3.Blood in the stool
Children often see a small amount of fresh blood on the surface of the stool or on the stool paper when they have a bowel movement, or drops of fresh blood. However, heavy bleeding is rare.
4.Other
Itching and discharge may occur in the child’s anal area, and some children with anal fissures may also have symptoms such as diarrhea.
Anal fissure examination
Pediatric anal fissures can be determined by observing the child’s anus, and the diagnosis can also be confirmed by some diagnostic methods. Generally speaking, no special examination is needed for pediatric anal fissures other than anal visualization, but if the cause is unknown or combined with other diseases, appropriate examination protocols will be used depending on the specific situation.
1. Rectal examination and endoscopy
For anal fissures that are difficult to diagnose, rectal palpation and anoscopy can be performed as appropriate, but should be done gently to avoid severe pain in the affected area.
2.Histopathological examination
For chronic ulcers located in the lateral position, think about whether there are rare lesions such as tuberculosis, cancer, Crohn’s disease and ulcerative colitis, and perform biopsy for differential diagnosis.
Differential diagnosis methods for pediatric anal fissures.
1.Anal injury: Anal canal injury caused by too rough anal examination or too dry stool or trauma, the wound is fresh and superficial, bright red, relatively more blood in the stool and severe pain, the fissure can occur in any part of the anus and can mostly heal itself. A history of obvious trauma or constipation.
2, anal fissures: this situation children are mostly accompanied by anal eczema, dermatitis, anal pruritus and other evidence, due to the skin around the anus leathering prone to fissures. The fissures are mostly distributed in the skin around the anus, the fissures are superficial, irregularly distributed cracks, light pain, little blood in the stool, no anal papilla hypertrophy, sentinel hemorrhoids and other foreign body protrusions. It also occurs when the stool is dry and painful during defecation.
3. tuberculous ulcers of the anal canal: the child has a history of tuberculosis, the shape of the ulcer is irregular, the edges are untidy, the bottom of the ulcer is a dirty gray mossy film mixed with purulent discharge, the pain is mild, there are no sentinel hemorrhoids, and the fissure can be in any part of the anus
4. anal ulcers of Crohn’s disease: the child has a history of Crohn’s disease, has had recurrent diarrhea, abdominal pain, low fever and other symptoms, and anal ulcers coexist with anal fistulae.
How can anal fissures be treated?
Children with anal fissures have difficulty defecating. Therefore, the principle of treatment for anal fissures is to soften the stool, keep it open, stop the pain, release the sphincter spasm, interrupt the vicious cycle, and promote the healing of the trauma. Specific measures are as follows.
1.Keep the stool open
Let the child take laxative or paraffin oil orally to make the stool loose and lubricated, increase multi-fiber food and change the stool habit to gradually correct the occurrence of constipation.
2.Local sitz bath
Before and after the child’s bowel movement, use 1:5,000 warm potassium permanganate coating solution to sit in the bath to keep the local clean.
3.Anal canal dilation
If the child’s anal fissure is serious, anal canal dilation surgery is required if necessary. Anal canal dilation is suitable for acute or chronic anal fissures that are not complicated by papillary hypertrophy and anterior sentinel hemorrhoids. The advantages are that it is easy to perform, no special instruments are needed, the treatment is rapid, and only daily sitz baths are needed after the procedure. After dilatation of the anal canal, the spasm of the anal sphincter can be removed and the pain can be relieved immediately after the operation. After dilatation, the anal fissure wound is enlarged and opened, drainage is unobstructed, and the superficial wound can heal quickly. However, this method has the disadvantage that it can be complicated by bleeding, perianal abscess, hemorrhoid prolapse, and short-term fecal incontinence, and has a high recurrence rate. Parents need to choose the right treatment method according to their child’s actual condition.
What is the best food for anal fissures?
One of the major causes of anal fissures in children is constipation, which has a lot to do with their daily diet. Therefore, for children suffering from anal fissures, parents can supplement the treatment with diet. Patients with anal fissures should eat more fruits and vegetables that are rich in fiber and vitamins to prevent constipation. Vegetables and fruits are rich in fiber and vitamins, so having your child eat them daily can make the stool soft and easy to pass, reduce the stimulation of dry and hard fecal pieces on the fissure wound, and promote wound healing. The following are some of the fruits that help anal fissure patients recover.
1, bananas: bananas are rich in dietary fiber, fructooligosaccharides, conducive to the growth of beneficial bacteria in the intestinal tract, when the beneficial bacteria in reproduction, will produce some organic acids, can stimulate intestinal peristalsis, improve constipation, prevent anal fissures, remind to eat cooked bananas.
2, pear: pear is not only tasty and juicy, sweet with acid, and nutritious, containing a variety of vitamins and fiber, constipation, digestion.
3, hawthorn: fresh hawthorn, walnuts, sugar, add water slightly boiled, drink frequently in lieu of tea, eat hawthorn, walnuts, nourishing, laxative effect, available to prevent dry mouth and constipation caused by fluid deficiency;.
4, dragon fruit: rich in fiber and pectin, helps water retention, can eliminate food and stomach, laxative, and contains vitamins A, C, B1, B2 and carotene and other nutrients.
In addition, sesame, honey, vegetable oil and pecan nuts can laxative and laxative, so children with anal fissures should eat more of them appropriately. Children with anal fissures have dietary contraindications. They should avoid or eat less stimulating diet, such as chili, ginger, garlic, onion, etc. These foods can lead to constipation and make the anorectal area significantly congested, triggering or aggravating anal fissures. Parents should give their children more of the above-mentioned vegetables and fruits and avoid allowing them to eat forbidden foods.
Anal fissure prevention
Anal fissures in children are painful and difficult to defecate, and can lead to many physical symptoms, so it is important to prevent them. The prevention of anal fissures should be mainly done as follows.
1, to keep the stool smooth, let the child develop the habit of regular bowel movements every day, found stool dry, do not blame defecation, but to use warm salt water enema or open plug injection anal laxative.
2, timely treatment of the child’s anal fossa inflammation, in order to prevent the formation of ulcers and subcutaneous fistula after infection.
3. timely treatment of various diseases that cause anal fissures, such as ulcerative colitis, to prevent the occurrence of anal fissures.
4.When examining the child with an anal speculum, avoid using the speculum to operate roughly and damage the anal canal.
5, parents should pay attention to the preparation of the child’s diet, less children eat spicy stimulating food, food should not be too fine, coarse and fine food, vegetables and other fiber-rich food as much as possible to intake, can keep the stool normal.
Do the above points, the chances of children suffering from anal fissures will be greatly reduced.