Definition

• An anal fissure is a shallow tear in the skin around the anus
• This is the cause in over 90% of children with blood in the stools

Health Information

Symptoms

• It causes blood on the surface of a stool.
• Blood may also be found on toilet tissue after wiping.
• The blood is always bright red.
• Only a few streaks or flecks are seen.
• You may see a shallow tear at 6 or 12 o’clock on the anus.

Cause

• Anal fissures usually are caused by the passage of a large or hard stool.
• Wiping dried stool off the anus can also cause a fissure.

Care Advice

1. Overview:
   • An anal fissure is the most common cause of blood in the stools.
   • It is caused by passing a hard or large stool.
   • Here is some care advice that should help.
2. Warm Saline Baths:
   • Give a warm salt water bath for 20 minutes.
   • Add 2 ounces (60 ml) of table salt to a tub of warm water. You can also use baking soda.
   • Do 2 times per day for 1 day to cleanse the area and to help healing.
   • Don’t use any soap in the water or on the anus.
3. Steroid Ointment:
   • If the anus seems red, use 1% hydrocortisone ointment. No prescription is needed.
   • Put a little around the anus.
   • Use 2 times per day for 1 day to help healing.
   • Could also use petroleum jelly to protect the anus while it heals.
4. High-Fiber Diet:
   • For children more than 1-year-old, change the diet.
   • Increase fruits, vegetables, and grains (fiber).
   • Reduce milk products to 3 servings per day.
   • Treat constipation if that is the cause.
5. Prevention of Anal Fissures:
   • Keep the stools soft and release them daily
   • Cleanse the anus gently with warm water after passing stools.
6. What to Expect:
   • Bleeding from a fissure will stop on its own in a few minutes.
   • Most often, anal tears heal up quickly in 1 or 2 days.

Call Your Doctor If

• Bleeding gets worse
• Small bleeding occurs more than 2 times
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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