Since birth, the condition of the baby’s stool is the main concern of the parents. The whole family gets very nervous when the child has a difficult bowel movement or blood in the stool. So what diseases can make a baby’s bowel movements so painful? The first disease that comes to mind when a baby exhibits anal pain with blood during defecation is – anal fissure. Anal fissure is a common disease in pediatric anorectal surgery, which occurs from birth to adolescence, mostly in children over 1 year old. Is an anal fissure a cracked anus? It can be taken literally as a fissure of the anal canal. Anal fissure is a small ulcer formed after a fracture of the skin layer of the anal canal below the dentate line, which is oriented parallel to the longitudinal axis of the anal canal, about 0.5 to 25px long, pike or oval in shape, often causing severe pain and difficult healing. Anal fissures often occur in the posterior and anterior middle of the anus, mostly in the posterior part of the anus and less frequently on both sides. Initially, there is only a small fissure in the skin of the anal canal, but sometimes it can be fractured to the subcutaneous tissue or to the superficial layer of the sphincter. The fissure is linear or prismatic, and if the anus is opened, the fissure becomes round or oval in shape. Why do babies get anal fissures? There are many causes of anal fissures. The most important factor causing anal fissures in children is dry, hard stool or a foreign body. A coarse, hard stool that exceeds the limit of compliant anal dilation may lead to a tear in the mucous membrane of the anal skin, usually forming a longitudinal fissure in the upper and lower midline of the anal canal, which is the main cause of anal fissures. Parents who pay attention will find that most babies with anal fissures have dry stools that lead to blood in the stool and anal pain, and the fissures are only discovered when they are further seen. There is also a small percentage of infants who have good stools and are not constipated who also develop anal fissures, and the cause of these infants’ anal fissures is not as clear. Do anal fissures always have blood in the stool? The main symptom of anal fissure is pain in the anus when passing stool, accompanied by a small amount of fresh blood. However, blood may not always be present in every stool. Parents may notice blood on the baby’s stool or a small amount of blood coming out of the anus in drips after a bowel movement, or a smaller amount of blood when wiping the anus with a tissue. At the same time, the baby may cry during a bowel movement or tell the parents that “his buttocks hurt”. Once the fissure is present, the next time the child has a bowel movement, the wound will be pulled and stimulated, and pain and bleeding may occur. Early fresh anal fissures have blood as the main symptom and are slightly less painful. If they do not heal, they will become old anal fissures after 2-3 months with more intense pain, and the amount of blood in the stool will be reduced in some children instead. Do I need to go to the hospital for anal fissures? If parents suspect that their baby has an anal fissure, they can check it when they wash the baby’s anus after defecation: it is best for one parent to hold the child so that the baby’s anus is relaxed and open, which is convenient for parents to observe. Some babies are in severe pain and do not allow parents to look at them, so you can gently peel open the anus while the child is sleeping to observe. If the symptoms appear for a short period of time, you can start with the following points and expect the anal fissure to heal itself: 1. Relieve your baby’s constipation and develop good habits of defecating on time. The chronic inflammatory reaction of the fissure will lead to the proliferation of local granulation tissue and the formation of small protruding fleshy flab, which is a characteristic of chronic anal fissures, and once it reaches the chronic stage, the possibility of self-healing is relatively low. Defecation, and patiently and regularly every day, can develop the habit of defecation on time. Many children have good constipation, and the anal fissure will slowly heal itself. 2. Let your baby have the right amount of activity. Late neonatal period, you can let the child fasting prone, the baby is slightly larger, you can let it roll and crawl in bed, which is not only conducive to the prevention of constipation, but also beneficial to the child’s healthy development. And then a larger child, more running, jumping exercise during the day, is conducive to intestinal peristalsis, relieve constipation. 3, scientific feeding, breastfeeding. Try to breastfeed before the age of six months, after adding complementary foods should be combined with its physiological characteristics, have a reasonable dietary structure. The intake of adequate protein, but also must be consumed in the appropriate proportion of carbohydrates and fresh vegetables containing fiber, which has a greater role in the prevention of pediatric constipation. 4, keep the anal local cleanliness and hygiene. If your baby has an anal fissure, parents should gently wipe it clean with a soft tissue after each bowel movement, or rinse the anus with warm water, followed by a sitz bath with warm saline for 5-10 minutes, or apply erythromycin eye ointment, which can play a local disinfection and accelerate the healing effect of the fissure. If the fissure does not heal after a period of adjustment, parents are advised to take the baby to the hospital for examination and treatment. Do anal fissures need surgery? Generally speaking, for children with anal fissures, the above-mentioned conservative treatment methods are mainly used. The constipation is eliminated, the fissure grows well, the inflammatory stimulation subsides, and the flesh may slowly flatten out, but it takes a longer time. It can also be surgically removed, mainly for old anal fissures and comorbidities such as combined external hemorrhoids, enlarged anal papillae, and anal fistulas, and is best done when the child is older. Can anal fissures recur? Both conservative and surgical treatment have a certain recurrence rate, which is closely related to the baby’s bowel movements, so it is important to treat both constipation and anal fissure, and if constipation is not relieved, the healing of the fissure may be temporary.