Clinical Reference Systems: Pediatric Advisor 10.0
An anal fissure is a shallow tear or crack in the skin at
the opening of the anus. More than 90% of children with
blood in their stools have an anal fissure.
- The blood is bright red.
- The blood is only a few streaks or flecks.
- The blood is on the surface of the bowel movement (BM) or
on the toilet tissue after wiping.
- Your child usually passes a large or hard bowel movement
just before you notice the blood.
- You may see a shallow tear at the opening of the anus
when the buttocks are spread apart, usually in a clock
position of 6 or 12 o'clock. However, a tear cannot
always be seen.
- Touching the tear causes mild pain.
Injury to the anal canal during passage of a hard or large
BM is the usual cause of anal fissures.
Bleeding from a fissure stops on its own in 5 or 10 minutes.
- Warm saline baths
Give your child warm baths for 20 minutes, three times a
day. Have him sit in a basin or tub of warm water with
about 2 ounces of table salt or baking soda added.
Don't use any soap on the irritated area. Then gently
dry the anal area.
- Bowel movements
After bowel movements gently cleanse the anus with warm
water. Do not use dry toilet tissue until the fissures
If the anus seems irritated, you can apply 1%
hydrocortisone ointment (nonprescription). If the pain
is severe, apply instead 2.5% Xylocaine or 1%
Nupercainal ointment (nonprescription) three times a day
for a few days to numb the area.
The most important aspect of treatment is to keep your
child on a nonconstipating diet. Increase the amounts
of fresh fruits and vegetables, beans, and bran products
that your child eats. Reduce the amounts of milk
products your child eats or drinks.
Occasionally a stool softener (such as mineral oil) is
CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:
- The bleeding increases in amount.
- The bleeding occurs more than two times (after treatment
- You have other concerns or questions.