Anal fissure in children is a disease that many parents may not know about, and those who do know about it mostly don’t consider it to be much of a problem. It is so minor that many pediatric textbooks do not write about it, and if they do, they do so in a few sentences, leading many doctors to not know much about it either. It is also true that anal fissure is a fissure in the anus that is a little painful and bleeds a little, and some children grow out of it on their own without treatment. In the past, I thought so too, but after I left the specialist clinic, I found that this disease actually occupies a large proportion of the general specialist clinics, and it causes a lot of pain to many children, but it is generally ignored by parents and doctors. To treat anal fissures, first treat constipation As mentioned in the article on functional constipation, constipation can trigger anal fissures. A coarse, hard stool that exceeds the limits of compliant anal dilation can lead to a tear in the anal skin mucosa, usually forming a longitudinal fissure in the upper and lower midline of the anal canal, which is probably the main cause of anal fissures, so most children with anal fissures have a history of constipation. However, not all children, and many children with anal fissures under the age of 1 have good stools and are not constipated, and the cause of some anal fissures is not as clear. Once an anal fissure is present, the next time the child has a bowel movement, the wound is pulled and irritated, and pain and bleeding may occur, manifested by the child being afraid to have a bowel movement, crying in pain during a bowel movement, blood on the surface of the bowel movement, or blood dripping from the anus after a bowel movement, and sometimes more bleeding after a deep fissure. As mentioned earlier, constipation is the main cause of anal fissures, and solving the problem of constipation is the key to treating anal fissures. Only when the anus is no longer repeatedly opened by dry, hard stool will the fissure have a chance to heal, and in many children, when the constipation gets better, the fissure will slowly grow back on its own. Symptomatic treatment In addition, we can also use some symptomatic treatment for the local wound of the anus, mainly to keep the area around the fissure clean, such as using a sitz bath with warm water or potassium permanganate solution, especially after a bowel movement, not only to clean and disinfect, but also to improve local blood circulation, which may promote healing. With these conservative treatment methods, most acute anal fissures can heal in about 2 weeks. For chronic anal fissures in children, the conservative treatment methods mentioned above are also mainly used. After the constipation is eliminated, the fissure grows well, the inflammatory irritation subsides, and the flesh flab may be slowly flattened, but it takes a longer time, and of course it can be surgically removed. There are also local topical nitroglycerin ointment, local anesthetic cream, diltiazem ointment and other methods in the anus, the purpose is to rely on these drugs to relax the anal sphincter to prevent the wound from being propped up again, but the conclusion of the current study is that these drugs are only a little stronger than placebo, and some of them also have headaches, short-term anal fecal dirt and other side effects, and are rarely used in China. Surgical incision of the internal sphincter is the last option for the treatment of anal fissures, and because of the risk of postoperative anal incontinence, it is rarely used for the treatment of anal fissures in children in China.