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Clinical Reference Systems: Pediatric Advisor 10.0
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Anal Fissure


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.


  1. 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.

  2. Bowel movements

    After bowel movements gently cleanse the anus with warm water. Do not use dry toilet tissue until the fissures are healed.

  3. Ointments

    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.

  4. Diet

    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 needed temporarily.


  • The bleeding increases in amount.
  • The bleeding occurs more than two times (after treatment begins).
  • You have other concerns or questions.



Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems