An anal fissure is a split or tear in the skin and muscle layers around the anal opening, usually at the back.
The cause is unknown but is thought to be due to forceful stretching of the opening by passage of a large, hard stool. This certainly seems to be the cause in infants and children.
The condition is extremely painful, usually only on emptying the bowel. This pain in small children may cause them to hold on to the motion and become increasingly constipated.
It may be recognised in the infant too young to complain by the fact that he screams when passing a bowel motion and the stool maybe streaked with blood.
Treatment is successful. Mild cases may be managed by the topical application of local anaesthetic and then stretching the anus with a special dilator.
A short-acting but deep general anaesthetic and then forcibly stretching the anal margins by inserting eight fingers will be followed by rapid relief of symptoms and cure within days.
Chronic fissures with the development of thickened scar tissue may require operation.
In children, local anaesthetic and an agent to soften the stool may be sufficient.
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