A rupture or tear in the inner lining of the anus, usually in the middle and poterior portion.
There are many causes, including the passage of large hard stools, prolonged diarrhea, inflammatory diseases of the colon and infectious diseases (syphilis, tuberculosis). In childhood, the most common cause is constipation due to the passage of hard stools that can damage the anal mucosa.
It manifests itself as severe anal pain that increases with defecation. It may bleed, typically staining the toilet paper after defecation. The child may cry and even refuse to have a bowel movement, creating a vicious circle that leads to the formation of harder and larger stools that are difficult to evacuate.
The diagnosis is made clinically, by questioning and exploring the area.
Most cases are resolved with conservative treatment. It is important to avoid constipation and hard stools by eating fiber-rich foods and keeping well hydrated. Other drugs used include laxatives, local anesthetics in cream, vaseline or combinations of hydrocortisone and zinc oxide. In severe cases, surgical repair may be necessary.
- Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg 2011; 24:22.
- Perry WB, Dykes SL, Buie WD, et al. Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum 2010; 53:1110.
- Elizabeth Breen, Ronald Bleday. Anal fissure: Clinical manifestations, diagnosis, prevention. UpToDate, Jun 08, 2015.
- Rizwan Ahmed, Susan L Gearhart. Diverticulosis y trastornos anorrectales frecuentes. Harrison. Principios de Medicina Interna. Volumen 2. 19ª Edición. 1971:1978
- E. Moreno-Osset, M. Mínguez Pérez, A. Benages Martínez. Enfermedades del recto y del ano. Farreras Rozman. Medicina Interna. Volumen I. Duodécima edición. 197:200.
- María García Ávila, Eva maría Aguilar Blanco, Ángel Blanco Bravo. Urgencias en proctología. Manual de protocolos y actuación en urgencias. Hospital Virgen de la Salud, Complejo Hospitalario de Toledo. Tercera edición. 2010.485:490.
