Violation of the integrity of the wall of the final section of the rectum is called an anal fissure. This pathology is quite common.
In adults, this disease is more common than in babies. A child can get sick at any age. In boys, the disease is equally common, as in girls.
Cracks in the anus in the structure of diseases of the rectum take third place after hemorrhoids and colitis. The length of this defect may vary. In most cases, children have a crack up to 2-3 cm in size.
In a newborn baby, the length of the defect may be less, but the disease proceeds with the appearance of many uncomfortable symptoms. The crack is localized in the anus, near the anal sphincter.
Reasons for the appearance
Quite often, various traumatic causes of the development of an anatomical defect in the region of the final section of the rectum damage during bowel movements. This is facilitated by constant straining during a trip to the toilet.
Problems with stool in a child occur mainly due to chronic bowel disease.
Various pathologies of the final sections of the gastrointestinal tract, manifested by colitis or proctitis, according to statistics, are the most common causative factors for the appearance of defects in the rectal mucosa. The damage width in this case is usually 1-3 mm.
A crack is a wound surface, which can become an input "gate" for the penetration of pathogens.
Initially, the defect looks like a small rupture of the mucous membrane, which is located next to the anus. After some time, the size of the developed anatomical defect increases. Its edges begin to thicken, and the central part loosens.
In appearance, such a defect resembles a trophic ulcer. Usually, this pathological process is exacerbated by the development of a strong sphincter spasm.
Prolonged spasm of the final sections of the intestine leads to the disruption of the full blood supply and innervation of the damaged zone and anus. This condition contributes to the chronization of the process.
The lack of treatment leads to the fact that the acute process becomes a persistent chronic form. In this case, the treatment of long-term current pathologies of the anus is quite difficult.
Persistent constipation in babies, they are often the main cause of the development of anal fissures. Solid feces, passing through the distal colon, contributes to damage to the delicate mucous membranes.
This situation not only leads to the development of chronic colitis and proctitis, but also forms a crack in the anus. The first manifestations of persistent constipation, according to statistics, appear in babies aged 2-3 years.
Another common reason for the appearance of an anal fissure in childhood is helminthic invasion. Parasites living in the intestines secrete toxic products of their vital activity, which have a damaging effect on the mucous membranes. Also, helminth infection causes persistent constipation in a child.
The appearance in a child of severe itching in the anal sphincter should draw the attention of parents to this problem.
Manifestations of anal fissure in babies can be very different. In infants, the disease is manifested by the appearance of severe crying during the act of defecation. There may not be any external signs of the disease on the pope of the baby.
Changes in behavior and a sharp deterioration in the mood of the child during bowel movements should greatly alert parents and become an occasion to see a doctor.
The appearance of too hard or "sheep" feces is also an unfavorable symptom. The long-term preservation of this clinical sign will entail very unpleasant consequences in the form of the development of colitis or traumatic damage to the wall of the rectum with the development of an anal fissure.
Normally, the baby's stool should be soft, brown, in sufficient volume. Undigested pieces of eaten food may be stored in it.
The appearance of bloody streaks in the feces is another dangerous symptom. This symptom often indicates the presence of bleeding in the final sections of the large intestine.
During an exacerbation of the anal fissure in a child, behavior changes greatly. Kids become moody, often whimpering. Children under three years old are more often asked for in their arms.
While in a crib, a sick child often changes body position. Prolonged sitting can contribute to increased pain.
This symptom is especially pronounced in schoolchildren. It is quite difficult for a sick child to endure all 5-6 lessons at a desk. Some babies note that they have increased soreness after hot baths.
A history of an older child has important diagnostic value. As a rule, the kids tell the doctor or mom well what is bothering them.
During communication with the child it is very important to establish psychological contact. An anal fissure is a very delicate problem, especially in adolescence, when a child delimits the boundaries of his personality from the outside world.
When communicating with a teenager about the symptoms that have occurred to him, try to make the baby feel that you are on his side. Friendly attitude and support are very important for him during this period.
Be sure to explain to the child that this is a disease that needs to be treated. During the conversation, focus on the fact that, following all the recommendations of the doctor, this disease will quickly heal.
In young children who cannot yet tell their parents what is bothering them, they should rely on the totality of the symptoms that appear in the child.
Adverse frequent clinical signs of defects in the rectal mucosa include:
- the appearance of pain during an act of defecation,
- a large amount of mucus and streaks of blood in the feces,
- increased soreness during active movements or after hot baths,
- persistent constipation
- a strong change in the behavior of the child.
The appearance of these symptoms should motivate parents to consult a pediatric proctologist.
Proctologists prescribe therapy for defects in the anal area. These specialists conduct the necessary complex of examinations, which allows to exclude concomitant pathologies and make the correct diagnosis.
In some cases, gastroenterologists and surgeons join the treatment. The need to contact these specialists is determined by the attending proctologist.
To eliminate adverse symptoms, apply a whole complex of treatment, which includes many different methods:
- prescribing drugs
- compliance with the regimen of the day and medical nutrition,
- conducting a regular hygiene regimen necessary for a particular child.
The main goal of therapy is to eliminate all the provoking causes that led to the development of damage in the anal sphincter.
Drug treatment in the treatment of anus fissure is important. Medicines can restore the integrity of the mucous membranes, contribute to rapid regeneration (recovery), and also have anti-inflammatory effects.
Medications are usually prescribed in different forms of release. Quite often, various suppositories and ointments are used to treat anus cracks.
The purpose of prescribing treatment in the acute stage of the disease is to relieve pain and severe spasm in the anal sphincter. The most effective remedies for this are antispasmodics. They have a pronounced relaxing effect on smooth muscles, including the intestinal wall.
Drotaverinum or Meloxicam also have an excellent anti-inflammatory effect.
Rectal suppositories are necessary in treatment for the rapid healing of injured tissues of the final intestine.
Sea buckthorn suppositories have an excellent anti-inflammatory effect. They can be used in babies even at a very young age. These drugs have a minimum of side effects and can be used very safely in babies.
The frequency and duration of use of these drugs is determined by the attending physician.
Many medicinal suppositories contain in their composition several biologically active components that have a whole range of actions. Their use helps to reduce pain, has an anti-inflammatory effect, helps prevent secondary bacterial infection of damaged tissues, and they are also necessary for quick regeneration.
Rectal suppositories containing propolis, help relieve severe inflammation in the anal area and prevent the development of dangerous complications of the disease.
All suppositories are inserted into the rectum. Typically, the frequency of use is 1-2 times a day. It is better to introduce suppositories after hygiene procedures. Before introducing a candle into the anus, you should talk with the baby and explain to him what will happen.
For the smallest children, such treatment should be carried out in a playful way. This helps to prevent a strong fear in the baby during the introduction of the candle into the anus.
For suppositories, which include plant components in their composition, there are contraindications. Basically, they are the presence in the child of an allergic reaction to certain components of the drug. Such treatment should be carried out very carefully, observing all safety precautions.
If the child has a pronounced allergy to various substances, you should first consult with your doctor about the possibility of using a specific medicine.
To soften feces, a special diet is used. It includes the mandatory observance of the drinking regime. The large intestine is an organ involved in the reverse absorption of water, which enters the body from outside.
If there is not enough fluid, then over time the baby develops symptoms of solid feces. For a normal density of feces, a child must drink the daily age-specific norm of fluid.
To form a soft stool, coarse fiber must be present in the children's diet. It contributes to the formation of feces that are normal in volume, which do not cause constipation in the baby.
Coarse fiber is found in all fruits and vegetables. For the process of normal digestion, the baby should eat a sufficient portion of plant foods during each meal.
To eliminate the pain syndrome that appears in the anus in the presence of anatomical defects, doctors quite often recommend using various microclysters.
Such treatment is carried out by the course. As an enema liquid, decoctions of medicinal herbs or boiled water are used. Quite often, a chamomile is used in children.
Microclysters should be carried out as carefully as possible so as not to additionally injure the damaged rectum.
Various physiotherapeutic methods are used to eliminate the adverse symptoms of chronic anal fissure in babies.
Ultrasound with novocaine, magnetotherapy or phototherapy have a moderate anti-inflammatory and wound healing effect. These methods will be effective only when assigned to courses. They also help eliminate severe spasm of the anal sphincter and improve blood circulation to the pelvic organs and abdominal cavity.
In some cases, conservative treatment is ineffective. This situation mainly arises when a baby has a significant defect in volume. In this case, surgical treatment is already required. The volume and type of operation is chosen by the pediatric surgeon or the operating proctologist.
Surgical treatment in this case usually consists in excising the affected tissues and stitching the wound sites together.
After the operation, the resulting biological material is sent to the laboratory. A histological examination is performed there. It helps doctors exclude dangerous neoplasms of the rectum, which are often "dumb" and do not cause specific symptoms.
Also, with the help of histological examination, it is possible to establish the morphological characteristics of the disease, which caused the development of an anal fissure in the baby.
You can find out how to treat an anal fissure with folk methods by watching the video below.
Why do cracks appear in adults and children?
As a rule, the cause of anal fissure in adults and children is associated with their lifestyle, nutrition, living conditions, as well as the presence of other individual factors.
The main causes of irritation and cracks around the anus are as follows:
- Frequent constipation, which forces a person to constantly strain the pelvic floor muscles, creating excessive pressure in the rectum. Over time, organ tissues wear out and do not withstand such intense pressure. As a result, small damage is first formed, which manifests itself in the form of irritation, and then the area of damage to the rectal mucosa only increases.
- Mechanical injuries. Too hard feces can injure the smooth walls of the rectum and cause microcracks, which tend to progress and deepen in the future in their wound surface.
- Hard birth. During the passage of the baby through the birth canal in the pelvic area of a woman, a critical level of pressure is created on all internal organs. In the presence of weak tissues of the rectum, their rupture is not excluded with the formation of cracks of various depths and severity.
- Lack of hygiene. Redness near the anus can be triggered by ignoring basic hygiene standards. First, irritation forms around the anus, and then a red rash and diaper rash spread to the surface of the anus and the mucous membrane of the rectum. In some cases, non-compliance with hygiene rules leads not only to the formation of wound surfaces on tissues, but also to the development of parasitic infections in the form of a fungus. These pathologies require special treatment, which should be aimed at ridding the anal of pathogenic microorganisms and restoring stable bacterial microflora.
Much less frequently, changes in the mucous membrane in the rectum are provoked by the presence of chronic proctitis, infection by worms, and intestinal dysbiosis. In any case, an adult or a child should undergo a comprehensive examination after detecting irritation in himself around the anus.
What do the symptoms look like?
The wider and deeper the wound in the rectum, the stronger the adult or child feels characteristic discomfort in this part of the body. You should beware and pay special attention to your health if the following symptoms are observed:
- there is irritation and redness around the anus after defecation,
- periodically inflamed anal, which combines with a feeling of pain and itching at the same time,
- pain in the anus becomes more prolonged,
- blood feces of scarlet color are observed in feces (in case of damage to the veins dark venous blood may appear),
- periodic bleeding from the anus (indicates that the crack in the rectum is deep enough, and the inflammatory process progresses).
These signs of a pathological condition of the rectum can develop in both an adult and a child.
Therefore, it is extremely important to monitor the quality of your stool, take measures in case of constipation and monitor the cleanliness of the feces for the presence of circulatory secretions.
In the process of treating irritation and redness around the anus, as well as performing therapeutic measures aimed at getting rid of a crack in the rectum, a strict diet should be followed, which helps to normalize stool. Adults and children are strictly forbidden to eat the following types of food and dishes prepared on their basis:
- fried using vegetable or animal fats,
- any spices except bay leaf,
- alcoholic drinks,
- fresh cabbage, legumes, not cooked vegetables and fruits,
- bakery products and pastries,
- whole milk.
Adults and children suffering from a crack in the anus and in the deeper tissues of the rectum, it is recommended to eat boiled cereals from cereals and oatmeal on an empty stomach. Before each meal, the patient should drink 1 teaspoon of vegetable oil (olive or sunflower). Throughout the day, you need to drink a large amount of liquid, so that intestinal motility works actively and there is no formation of constipation.
Ointments and herbs
The method of treating a crack in the rectum in each individual case is individual and is developed by the doctor proctologist, in whom the patient is observed. In the arsenal of the doctor there are such modern ways to rid a patient of a wound in the anus:
- Trays of medicinal herbs. The patient previously prepares a medicinal decoction of chamomile based on a ratio of 30 grams of dried grass per 1 liter of water. Then, the resulting liquid is added to warm water, the temperature of which should not exceed 30 degrees Celsius. The patient sits in the bath and soars the pelvic area in warm water for 10-15 minutes. This procedure not only relieves inflammation in the rectum, but also removes irritation, as well as redness around the anus.
- Ointment. This type of drug is applied to the surface of the anus 2 times a day in the morning and evening. As a rule, the duration of treatment lasts no more than 7-10 days. The most effective in the treatment of anal fissures are ointments - Ultroprokt, Solcoseryl, Methyluracil, Katedzhel, Aurubin, Levomekol.
- Suppositories. One of the most convenient and effective forms of drugs that can quickly penetrate into the venous blood of the hemorrhoid plexus, relieve the inflammatory process, remove pain and normalize blood circulation in the pelvic organs. Candles at the same time perform the function of healing a crack in the rectum and act as an excellent laxative, since their base is made using cocoa butter. In medical practice, the suppositories Relif, Anestezol, Proctoglivenol, Fiberal are most often used. The selection of the drug is performed exclusively by the doctor proctologist.
There are times when parents lead a child with chronic constipation to see a doctor. There are no complaints about pain, and an anal fissure is diagnosed during a medical examination of the anorectal zone.
Early diagnosis can protect against serious diseases of the rectum
The doctor dilutes the walls of the anus to exclude or detect the presence of the disease. If pain occurs with a digital examination, then the place of the alleged pathology is anesthetized with novocaine.
Causes of pathology
Most often, the tear of the mucous membrane of the anal canal is due to the movement of solid feces along it.
There are other causes of cracks in the anus. For example, diarrhea of different origin or inflammation of the rectum contribute to the formation of swelling of the mucosa, which is easily damaged.
Helminthic infestations cause severe itching in the anus. By constantly combing the child provokes the formation of a wound. The appearance of a crack can also be a consequence of injuring the tender zone during the setting of an enema.
An extreme method of treating a crack in the anus is surgery. The surgeon proctologist can use the following methods of surgical treatment of the patient, namely:
- devulsion (artificial expansion of the sphincter to treat the anal fissure with the application of potent anti-inflammatory drugs directly to the wound surface),
- cryodestruction (with the help of liquid nitrogen, damaged fragments of tissues of the rectum are removed, which speeds up the healing process of the mucous membrane),
- sphincterotomy (a standard surgical procedure that involves stitching the edges of a crack within healthy tissue).
The method of surgical treatment largely depends on the stage of development of the disease and the depth of crack formation in the tissues of the rectum. Surgical intervention in 85% of cases brings a lasting therapeutic effect and contributes to the full recovery of the patient.
Treatment of anal fissures in children is carried out by conservative methods.
The main goals of therapy are to normalize stool, relieve sphincter spasm and relieve pain. To achieve the desired effect, you must follow a diet rich in plant fiber. And all spicy, sour, salty, fatty and fried should be excluded from the diet menu.
The treatment regimen looks like this:
|Elimination of pain and inflammation||Prescribe rectal suppositories, which contain anesthetics.|
|Therapeutic diet||In the diet menu, it is recommended to include fermented milk products, beetroot salad, and prunes. To relax, prescribe the intake of vegetable oil three times a day, 1 teaspoon or dessert spoon for a week.|
|Local therapy||Cracks are treated with antiseptic emulsions and sea buckthorn oil.|
Causes of Cracks
The causes of anal fissure in children and adults can be divided into 2 groups:
The first group includes pathologies that contribute to the appearance of a crack. Because of them, the mucosa of the anal passage swells, becomes inflamed and becomes vulnerable to mechanical damage:
- frequent constipation
- inflammatory processes in the intestines,
- taking laxatives.
Generating factors are directly mechanical damage to the tissues of the anus, that is, the passage of feces becoming solid in diseases of the gastrointestinal tract through the anus.
Anal fissure in children is a very common occurrence. The fact is that children usually have an underdeveloped digestive system, stool disorders in them on average occur more often than in adults. Diarrhea and constipation lead to inflammation of the rectal mucosa and, finally, to the anal fissure.
Before treating a crack in the anus in a child, it is important to visit the attending physician and get the appropriate appointment. But each parent of the patient needs to know how the drugs work, and why they are prescribed.
- Laxatives are not always required, but if the diet is ineffective, they must be included in the therapeutic plan. To normalize stool, the most safe and effective for the child's body are funds based on lactulose - a disaccharide from fructose and galactose. Such drugs reduce the pH in the intestines and affect the consistency of the stool. In the pharmacy, drugs based on lactulose can be found under the names:
- Dufalac (Germany) - the price is about 700 rubles per package,
- Lactusan (Russia) - the price is about 280 rubles per package,
- Prelaxan (Ukraine) - the price is about 200 rubles per package.
- Drugs that help normalize the digestion process help eliminate the cause of the pathology: constipation, dysbiosis and frequent diarrhea. Medications with this effect are available under the following names:
- Linex (Switzerland) - the price is about 700 rubles per package,
- Lactobacterin (Russia) - the price is about 200 rubles per package,
- fish oil - the price is from 30 to 1000 rubles, depending on the number of capsules and the manufacturer.
- As local remedies, you can use both traditional medicine recipes (oils) and suppositories with sea buckthorn extract. They effectively relieve inflammation of the mucosa, accelerate the regeneration process and reduce pain. The cost of the drug is about 100 rubles.
Drug treatment works only in conjunction. You can also apply other treatment options, for example, folk remedies, diet.
Stool normalization is an important part of treatment. First of all, you need to completely exclude from the diet of the child:
- salted and smoked products,
- convenience foods and fast food.
All these products have an irritating effect on the intestines, entail an increase in the anal fissure and increased symptoms: pain, itching, bleeding.
You should also limit the use of foods that can cause constipation:
- cottage cheese,
- fat meat,
You can consume these products, but in a strictly limited amount, observing the reaction of the intestine.
A child’s nutrition should consist of cereals in the water with a small amount of butter, poultry, and fruit. Vegetables can be consumed both fresh and boiled. For example, with anal fissure, vegetable puree soups are useful.
If the problem of constipation is already relevant, you can try to eliminate it not only medically, but also by adjusting the menu. The following products have a mild laxative effect:
- dried fruits,
- dairy products,
It is also important to observe the drinking regimen and consume a sufficient amount of liquid. The specific amount of water drunk per day is determined in conjunction with the pediatrician, depending on the age and existing diseases of the child’s endocrine or urinary system.
When breastfeeding, a woman needs to consult a pediatrician and, if necessary, change her menu.
Sedentary baths are a great way to cleanse wounds, reduce pain and spasm, and stimulate tissue regeneration. As a rule, a procedure lasting 10-15 minutes is carried out after each bowel movement until the symptoms of anal fissure disappear completely. Recovery most often occurs after 7-10 days.
For the bath, the water is heated to 37-38 degrees in a volume of 3 liters, which is poured into the basin. Often a weak solution of calcium permanganate (potassium permanganate) is used, such a solution is easy to prepare, it relieves muscle spasm of the anus and helps improve local blood circulation, that is, wound healing.
You can also use decoctions of medicinal herbs, such bathtubs will facilitate the condition and positively affect the speed of recovery:
|Chamomile flowers||It has an antiseptic and wound healing effect.|
|Calendula||Eliminates spasm of the anus, destroys microbes.|
|St. John's wort||It has antibacterial and wound healing effects, helps relieve swelling.|
|Yarrow||Relieves inflammation, reduces swelling.|
Preparation of a decoction is as follows:
- it is necessary to take at least 3 liters of water,
- bring it to a boil,
- add 3 tablespoons of the medicinal plant,
- remove from heat and cover.
Use for baths can only be chilled and filtered broth.
The purpose of microclyster is to soften feces. One of the causes of anal fissure is the stool hardness, which injures the surface of the anus, preventing wound healing and provoking pain.
Carrying out microclysters requires knowledge of several rules:
- the enema fluid should be warm, about 37 degrees,
- the volume of water for the enema is 100-150 ml,
- the injected liquid must be kept in the intestine for about one hour.
The procedure is carried out after a natural bowel movement. Then you need to prepare the solution, bring it to the desired temperature and pour into the syringe. The tip of the device is lubricated with petroleum jelly, after which an enema is performed. In order to keep the fluid inside for an hour, you need to lie on your left side.
For microclysters, you can use decoctions of herbs that are used for sitz baths:
- Before the procedure, you need to take about 200 ml of water,
- add 1 tablespoon of dried shredded plant,
- turn off and leave to infuse under the lid.
When boiling, the necessary volume of liquid remains - about 150 ml. After filtering, the broth is ready for use.
To enhance the therapeutic effect of a medicinal decoction, honey can be added to it. It has pronounced anti-inflammatory properties, so it allows you to see the therapeutic effect faster.
- A teaspoon of honey is mixed in the cooled water until completely dissolved.
- It is strictly forbidden to add honey to boiling water: when heated, it loses its healing properties.
- Also, honey can be bred in ordinary warm water.
But medicinal herbs and honey are not the only way to make microclysters with anal fissures. Oil enemas have a great effect. For this, any vegetable oils are used:
Oil needs to be slightly warmed up in a water bath and introduced through the syringe into the anus. In addition to the fact that the oil softens the stool, giving it the opportunity to exit painlessly, it has a therapeutic effect on the inflamed tissues of the anus, accelerating the regeneration process.
Microclysters should be done every day for at least a week, even if the symptoms of the pathology have passed earlier.
With an anal fissure, it is especially important to pay attention to the hygiene of the child:
- After each bowel movement, you need to thoroughly wash and dry your crotch.
- Underwear should be changed at least once a day, while the underwear should be comfortable, made of natural breathable material, well-sized.
Anal fissure is a common problem that many parents of babies face. Knowing how to recognize and treat pathology, you can not only quickly eliminate tissue damage in the anus, but also prevent its occurrence.
If the child does not have the urge to defecate, then you can help him with a cleansing enema. About 0.5 - 1 liter of cool herbal infusion will help soften feces and facilitate bowel movements.
Medicinal herbs can be different. This is chamomile, yarrow, St. John's wort, sage, peppermint, nettle dioica. They have a hemostatic, astringent, disinfectant and analgesic effect. The tip of the pear for an enema should be lubricated with petroleum jelly and administered with extreme caution.
Causes of anal fissure
The immediate causes of the disease can be divided into mechanical damage to the anal passage and damage to the mucous membrane as a result of sphincter tension.
Mechanical damage may occur:
- during bowel movements - due to damage to the mucous membrane by solid objects located in the feces,
- with anal sex
- during instrumental studies of the rectum, a crack may appear as a result of unqualified actions by medical staff.
Mucosal ruptures due to muscle tension mainly occur during exertion during bowel movements. Also quite often, rectal fissures can occur in women during childbirth.
It has long been established that the main factor provoking the appearance of a crack is chronic constipation. Constant attempts at bowel movements lead to increased muscle tension in the anus. In addition, solid feces have a negative effect on the condition of the mucous membrane of the anus. All this can lead to its rupture and cracking. More rarely, cracks can form as a result of diarrhea.
Some experts believe that hemorrhoids also contribute to the formation of cracks in the anus. Although there is another point of view, that hemorrhoids do not affect this process. These two diseases have many similar symptoms, but in general a different etiology, and approaches to their treatment are also very different. However, it is often possible to find the presence of both diseases in one patient at once.
Other factors contributing to the onset of the disease are:
- alcohol, too fatty, spicy or salty foods
- sedentary work
- weight lifting
- sedentary lifestyle
- diseases of the lower intestines - colitis, proctitis, irritable bowel syndrome
In addition, they contribute to the formation of cracks, although to a lesser extent, diseases of the upper gastrointestinal tract - a stomach ulcer and duodenal ulcer and gastritis, cholecystitis, blood diseases, leading to a violation of its coagulability and stagnation in the lower body.
Separately, it should be said about pregnancy and the birth process. These factors can also contribute to the appearance of cracks in the anus. In the first case, the reason is an increase in the size of the uterus and the associated difficulty in the process of defecation. This weakens the anus, and childbirth, accompanied by attempts, can provoke damage to the mucous membrane of the anus. Of course, in the first days after the birth, little attention is paid to this circumstance, but at the moment of the first bowel movement it will inevitably make itself felt.
Why do anal fissures appear?
An anal fissure is a longitudinal defect in the lining of the anal canal. Contrary to misconceptions, this disease occurs not only in adults, but also in children. The main cause of a crack in the anus in a child is persistent constipation. Hard feces, passing through the distal parts of the large intestine, damage the delicate mucous membrane. Usually persistent (not episodic) constipation appears in a child in 2-3 years. Therefore, for the first time, parents with children from 2 years old turn to a proctologist about a crack in the anus.
Among other reasons: anus injuries, various pathologies of the end sections of the gastrointestinal tract (colitis or proctitis).
After bowel movement
During treatment, parents must follow certain rules. After the child went to the toilet, it must be washed with cool water, always with soap. Next, you should introduce a candle with painkillers and make a warm bath with a weak solution of potassium permanganate.
The procedure takes 15 minutes. Now you need to wet the anus with a paper towel and treat with an ointment with an antibacterial and emollient effect.
Evening procedures are the introduction into the rectum of 50 ml of a warm broth of chamomile with a syringe and the treatment of the anus with ointment. It is carried out about an hour and a half before bedtime. And before going to bed, in the anus to a depth of about 2 cm, you need to enter a swab treated with sea buckthorn oil.
The course of treatment lasts up to three weeks. The doctor may prescribe a second course in two weeks if the treatment does not give the desired effect.
If the cracks do not heal for a long time, inject hydrocortisone (25 mg) with 2 ml of a 1% solution of novocaine. The usual course is 5 or 6 injections, which are injected under the crack every 2-3 days.
Most often, one course of therapy is enough to cure anal fissures in a child. In rare cases, the disease develops into a chronic form. As a rule, this happens in adolescence and requires the use of minimally invasive methods of treatment.
Specialists of the Fantasy Clinic
Doctor of Medical Sciences, Professor.
A very attentive, considerate and experienced doctor - experience over 28 years. Diagnoses and treats according to the principles of evidence-based medicine. Specialist in endoscopic surgery.
Work experience: Second Moscow State Medical Institute. N.I. Pirogov, Children's City Clinical Hospital No. 13 named after N.F. Filatova.
To make an appointment
Children are very rarely prescribed surgery to repair anal fissures. The cause of such a medical decision may be the formation of kallose cracks that do not heal after establishing a bowel movement within 1 - 2 months.
In this case, a wedge-shaped excision of the wall of the anal canal is performed and sutures are applied.
With the elimination of the extra-infectious pararectal fistula, Gabriel's operation is performed, when the wounds are left for re-healing.
What is dangerous
Rectal bleeding is not always a sign of anal fissures. Therefore, treating children on their own without a medical examination and a clear diagnosis is simply dangerous.
Inadequate treatment of an anal fissure in a child is dangerous with ulceration. Chronic constipation with such an ailment causes inflammation of the mucous membrane in the colon. Inflammation, in turn, can cause the formation of polyps in the rectum. In such situations, surgery is rarely avoided.
Causes of anal fissures in infants and children
An anal fissure is a violation of the integrity of the mucous membrane of the anus, which has a length of about 5 cm. A feature of the changes is that the tissues do not heal for a long time, so the disease has a chronic course. A crack is a polyetiological pathological condition. The fabric may crack due to several factors:
- Lack of proper hygiene procedures.
- Chronic constipation, accompanied by systematic damage to tissues by dense fecal masses during the act of defecation.
- Helminthic infestations - intestinal worms alter the functional state of the hollow structures of the digestive system, disrupt the normal intestinal microflora, and also cause mechanical irritation of various parts of the gastrointestinal tract.
- The development of food allergies triggered by certain foods (allergies are often caused by citrus fruits, strawberries, chicken, fish, food additives).
- Lactose intolerance is a pathological condition that predominantly has a congenital origin and is characterized by the absence of the digestive enzyme lactase. This disrupts the digestion of milk sugar (lactose) with a change in the functional state of the digestive system and the formation of an anal fissure.
- Poor nutrition - insufficient intake of potassium, fiber, liquid, the predominance of fatty, fried foods in the diet.
- Acute or chronic inflammatory pathology of various parts of the digestive system.
- Congenital malformations of the digestive system.
Knowing the reasons is important for the right choice of therapeutic tactics, as well as the implementation of preventive measures.
How to diagnose a crack in a child?
Diagnosis of a crack is carried out only by a doctor. First, he performs a clinical examination, it includes:
- Medical history - a survey of the child and parents regarding the time of the appearance of the main manifestations of the disease, their relationship with the physiological processes in the body.
- Inspection of the anus with identification of signs of an inflammatory reaction.
- Palpation - palpation of tissues of the area of development of pathological changes, regional lymph nodes. It is usually performed under local anesthesia, as it can provoke an increase in pain. For palpation of the walls of the rectum, a digital rectal examination is performed.
Based on the results of the clinical examination, the doctor makes an initial conclusion about the nature, severity of the course and the origin of the pathology. To clarify the diagnosis, an additional objective examination is prescribed:
- Clinical analysis of blood and urine.
- Biochemical analysis, including liver and kidney tests.
- Analysis of feces for occult blood and helminth eggs.
- Sigmoidoscopy - examination of the walls of the anus using a special optical device sigmoidoscope.
In pediatric practice, they are usually limited to clinical examination and laboratory tests. Sigmoidoscopy is indicated in severe cases of the disease, as well as in the case of the need for differential diagnosis with other diseases of the rectum.
The use of rectal suppositories
In most cases, an anal fissure forms on the mucous membrane of the rectum, so effective treatment involves the use of drugs in the form of a rectal suppository (suppository). In case of a disease in children, it is recommended to use the following means:
- Suppositories with calendula - have an antiseptic (lead to the death of bacteria, fungi), anti-inflammatory, analgesic effect.
- Aurobin - children's candles are intended for the treatment of cracks in an infant under the age of 1 year. They reduce the severity of pain, itching and inflammation.
- Alginatol is a drug for pathogenetic therapy that accelerates the course of tissue regeneration (healing) processes in the fissure area.
- Glycerin suppositories - have an enveloping effect, help soften feces, facilitate its passage through the rectum.
- Relief - candles based on shark liver. They have an immunostimulating and anti-inflammatory effect, stimulate the healing of damaged cells and tissues.
- Salofalk - candles can be used in children over 6 years old, they have a pronounced anti-inflammatory effect, while they do not contain hormones.
- Sea-buckthorn candles - contain natural components that have a good wound healing effect, can be prescribed to newborn children. They have received positive reviews and are also used to soften the stool for constipation.
The choice of suppositories for cracks in the anus for children is best provided to the doctor. He selects the dosage and duration of use of the drug individually.
Ointments are recommended for use when spreading a crack on the tissue of the sphincter of the anus. It is better to use drugs after going to the toilet and carrying out hygiene procedures. Popular drug names:
- Nitroglycerin ointment - reduces pain, accelerates tissue regeneration, reduces sphincter muscle tone, improves blood flow in the rectum.
- Ultraproct - ointment reduces inflammation, pain, itching of the anus. It is prescribed only by the attending physician.
- Levomekol - has an antiseptic effect, leads to the death of a large number of pathogens and conditionally pathogenic microorganisms, has the ability to heal tissues.
If necessary, ointments can be combined with the use of rectal suppositories, baths.
Medicinal herbs have anti-inflammatory, antiseptic effect. They contribute to the speedy healing of tissues, and also have an overall beneficial effect on the child. It is recommended to use nettles, a series of chamomiles, oak bark, mint, and a mountaineer. A decoction is pre-made, for which 1 tablespoon of the mixture of dry parts of one or more medicinal herbs is filled with 200 ml of boiling water. After cooling, the broth is added to the bath, where it is planned to bathe the child. It is important to ensure that the folds of the buttocks of the baby are completely immersed in water. The average duration of a swim is 10 minutes.
Rational nutrition has a positive effect on the functional state of the digestive system, and also contributes to the normalization of stool. It includes several important recommendations:
- Fractional frequent meals in small portions at least 5 times a day.
- Adequate intake of fluid in the body to prevent the formation of dense stools.
- Limit sweets, greasy, fried foods.
- The inclusion in the diet of fermented milk products (yogurt, kefir, yogurt) and vegetable fiber (porridge from buckwheat, barley, wholemeal bread).
- Dishes are best cooked, steamed or stewed. It is not recommended to grind the prepared dish to a puree state.
Compliance with dietary recommendations will help to avoid the development of other diseases of the digestive system.
The basic rule is to wash the anus after each bowel movement. It should be carried out with clean warm water or with a decoction of herbs that is used for baths. Use of soap is excluded. After washing, the area of the anus can be smeared with cream or ointment.
The lack of adequate treatment can cause the development of the following complications:
- Formation of a fistula (canal) in the wall of the rectum.
- Pectenosis is a pathological condition accompanied by the replacement of muscle tissue of the walls of the rectum with fibrous cells, which leads to a loss of elasticity.
- Infection of a fissure followed by the spread of bacteria into the fiber of the rectum. Perhaps the development of a purulent process in the form of an abscess or phlegmon.
- Ulcerative colitis - inflammation of the colon mucosa with the formation of ulcers.
- Sepsis is a blood poisoning.
What is dangerous anal fissure in children?
Pathology can be the cause of negative consequences for the health of the child in the future. These include chronic constipation, provoked by a change in the elasticity of the walls of the rectum, the formation of hemorrhoidal nodes. A prolonged violation of the integrity of the rectal mucosa can provoke the development of oncological pathology of the intestine in the future.
Doctor's advice for the treatment and prevention of anal fissures in a child
For the successful treatment and prevention of anal fissures in children, it is important to follow a few simple medical recommendations (tips and explanations taken from Dr. Komarovsky):
- Accustom the child to the systematic implementation of hygiene procedures.
- Ensure compliance with dietary recommendations.
- Timely consult a doctor with constipation and other signs of a possible crack formation.
- Discipline to carry out all doctor's prescriptions, as the disease can be treated at home.
- Do not self-medicate, which can cause complications.
- Use folk remedies only after consulting a doctor.
Timely and adequate treatment of an anus fissure in a child is the key to a favorable prognosis. It makes it possible to completely cure pathology, as well as to avoid complications and negative consequences in the future.
How to suspect a child has a crack in the anus?
- A typical symptom of an anal fissure is pain during and after stool, persisting from several minutes to several hours
- There may be a discharge of blood, scarlet, in a small amount
- In infants, the disease manifests itself in severe crying during bowel movements
- A sharp deterioration in mood while going to the toilet
- Too hard "sheep" feces. If it persists for a long time, it can lead to colitis or trauma to the wall of the rectum.
- In the crib, the child often changes body position. It can’t sit for a long time - for example, it’s difficult for students to have a school day at school.
With every act of defecation, an untreated crack is exposed to feces. This is especially dangerous for constipation when the stool is hard. In addition, a huge number of bacteria settle on the crack (as you know, human feces are more than half composed of bacteria). This leads to even more inflammation of the wound.
Untreated cracks located in the anus can lead to serious complications - acute purulent paraproctitis, the formation of fistulas, trophic ulcers, massive bleeding, gangrene and sepsis. In men, anal fissures increase the likelihood of prostatitis.
How to treat acute anal fissures?
They are acute and chronic. Acute is simply a rupture of the anoderm (it is smooth to the touch). Such an anal fissure in children lends itself well to conservative treatment. The following methods have proven their effectiveness:
- Elimination of constipation, relief of stool. This is mainly achieved by correcting the diet, first of all, with the help of additional consumption of dietary fiber.
- Sometimes prescribed a course of mild laxative. The chair in the child should be very soft, daily, he should not push.
- To alleviate symptoms, you can take warm sitz baths, especially relevant after stool,
- topical (local) remedies - suppositories and ointments containing painkillers and anti-inflammatory components.
How to treat a chronic anal fissure in a child?
The chronic form is accompanied by edema and fibrosis (on palpation, its edges are dense, rough). It is accompanied, as a rule, by a spasm of the anal sphincter. This means that pain causes a contraction of the muscle fibers of the sphincter, spasm leads to compression of the nourishing tissue of the vessels. Lack of blood supply interferes with the healing process. An unhealed crack again becomes a source of pain, and everything begins in a circle.
It is conservatively difficult to deal with chronic cracks. Treatment will not be effective without eliminating the spasm of the sphincter, so use local products containing nitrates or calcium channel blockers.
In an extreme case, the doctor discusses with his parents an operation - a dosed sphincterotomy, which allows you to remove the increased tone of the sphincter. The operation is indicated for treatment failure for 3-4, or for chronic, recurring anal fissures.
How to treat cracks in the anus?
Proctologists warn immediately that the treatment of anal fissures in adults is a long process, and the patient must approach him with special responsibility. The complete cure and the absence of relapse depends on the discipline of the person, because it includes not only drug therapy, but also diet and lifestyle changes in general.
Consider these three steps that should be taken to treat anal fissures in women and men.
Patients are advised to give up a sedentary lifestyle. The list of recommendations includes visits to the pool, hiking, cycling (allowed only after treatment). People in positions that do not imply activity during the day should rise every half an hour or an hour, do light exercises, walk up the stairs.
In the cold season, it is important to dress correctly, to cover the lower back and buttocks. In frosts, especially women, you need to wear thermal underwear or other warming clothes to exclude inflammation in the pelvis and rectum.
Particular attention should be paid to personal hygiene. After a bowel movement, the best option is to wash the area of the anus with warm water or use damp toilet paper. Traditional paper rolls are best removed for the time being.
Nutrition and Diet
To improve the functioning of the digestive tract, the patient is recommended to follow a therapeutic vegetable-milk diet. It is aimed at normalizing the patient's stool, eliminating periodic constipation, getting rid of diarrhea.
The fiber so necessary for normal digestion is found in fruits and vegetables. Their use will improve intestinal motility and establish a bowel movement. Lactic acid products contain lactobacilli, which are responsible for microflora.
Excluded from use should be:
- spicy dishes,
- marinades and canned foods,
- flour products
- fried and salty foods
- alcoholic drinks.
A distinctive feature of this diet is that in no case should you give up the use of animal and vegetable fats. There is an opinion that anal fissures and other problems of a similar nature are more common in those women and men who prefer a "fat-free" diet.
For breakfast, it is recommended to eat a salad of raw vegetables seasoned with vegetable oil. Thus, the gastrointestinal tract is activated, and the issue of possible constipation will be removed. Throughout the day, patients are advised to increase the use of laxative products. These are boiled beets and carrots, raw apples, dried fruits (prunes and dried apricots).
In cases where traditional medicine does not help, alternative methods can be used to treat anus fissures at home as an additional method.
- Celandine - stimulates the protective function of the body, promotes wound healing. 25 gr chop herbs, add 75 gr. St. John's wort, as much chamomile and yarrow. A third of the resulting mixture pour 250 g. boiling water. Wrap the container with a towel and leave for 2 hours. Take strained infusion in half a glass before meals.
- Propolis is the foundation of an effective homemade ointment. 75 gr. fat spread in enameled dishes, add 25 gr. beeswax, melt and mix with 25 gr. grated propolis, flax oil and liquid honey. The mass is well beaten and placed in a jar with a lid. Apply three times a day to lubricate the anal fissure. Store in the refrigerator.
- Aloe leaves - used to prepare an infusion for washing the anus and microclyster. To do this, chopped ripe leaves of the plant pour 250 g. boiling water, insist 30 minutes and filter. The tool can be taken orally by a quarter cup before eating.
Candles for anal fissures
Suppositories are a convenient dosage form that allows the main drug substance to be rapidly absorbed into the veins of the hemorrhoid plexus. In addition, candles are made on the basis of cocoa butter or other neutral fat, which simultaneously play the role of a laxative.
List of effective candles:
- Relief, Relief Advance 250-350 rub. and ointments and suppositories anesthetize, suppress inflammation, stimulate healing, prevent bleeding. Drugs are contraindicated until 12 years of age, with bleeding disorders and leukopenia, lactating and pregnant.
- Posterisan 200-300 rubles of ointment and suppository - hydrocortisone and E. coli killed by phenol. Under the same name, there is an ointment that can be used simultaneously for 1-2 weeks. Suppositories are contraindicated in early pregnancy.
- Aurobin - combined candles with an action similar to an ointment with the same name.
- Candles with methyluracil 60-80rub. stimulate the improvement of metabolic processes at the site of tissue damage, have immunomodulatory properties.
- Candles with sea buckthorn oil 100rub. effective in acute shallow cracks.
- Procto-glivenol 300-400rub candles and ointments are lidocaine, which reduces pain, and tribenoside, which stimulates venous outflow and relieves swelling.
Also suitable drugs with local painkillers that relieve pain and burning:
- Suppositories with belladonna extract 40 rub., Anuzol 60 rub. (Belladonna, bismuth tribromophenolate, zinc sulfate)
- Anestezole (benzocaine, bismuth subgallate, menthol, zinc oxide)
- Proctosan (lidocaine hydrochloride, bismuth subgallate, titanium dioxide).
When there is a chronic fissure of the anus, treatment is best done with combined agents containing painkillers and antispasmodics. Preparations in suppositories are used twice a day after bowel movements.
Ointments and creams for treatment
The following is a list of the most effective ointments that will quickly help eliminate the disease.
- Nitroglycerin ointment is the oldest, most common and effective way to treat anal fissure.
- Levomekol is an antiseptic that quickly heals wounds and blocks inflammation in the rectum.
- "Ultraproct" - not only disinfects wounds and promotes the healing of anal fissures, but also has a pronounced analgesic effect.
- Ointment "Rescuer". A well-known tool that we use to heal wounds. It has antiseptic properties, based on natural ingredients. Suitable for use even with chronic anal fissures.
- "Solcoseryl" - quickly restore good health, promotes cell regeneration and restoration of mucosal tissue. To enhance the effect, the ointment can be applied to a tampon and injected into the anus at night.
If using the diet it was not possible to achieve the necessary results, it is allowed to use mild laxative drugs that will not have a harmful effect on either the mother or the baby. These include Phytomucil, Normase, food bran.
With a stretched stool, it is worth using oil microclysters. For the procedure, you can use olive, liquid paraffin or sunflower oil. Oil is introduced in an amount of 50 ml. into the rectum with a syringe. This is an absolutely harmless procedure, so it can be used not only by pregnant women, but even if a woman has an anal fissure after childbirth.
In what cases is an operation scheduled?
If the prescribed treatment does not help, the anal fissure does not heal and continues to hurt, cause discomfort and bleed - the patient is prescribed surgery.
The essence of the operation is that the proctologist closes the cracks. The operation is simple, and in just three days the patient is ready to return to normal life and forget about the problem that bothered him. After the operation, you must follow a simple rule - to monitor your diet and prevent constipation and other mechanical damage to the anus.
Preventive measures are simple but effective. Recommended:
- If possible, empty the intestines at the first urge to defecate.
- Try to avoid constipation: drink 1.5-2 liters of pure water per day (it is “water” that is considered to be, and not other drinks), daily eat foods rich in fiber (cereals, vegetables, fruits).
- Wash the anus with warm or cool water after each bowel movement.
- Take time for physical activity. If it is not possible to engage in physical education daily, you can replace it with walking.
If you experience recurring constipation or the appearance of symptoms of other problems with the gastrointestinal tract, you should immediately consult a doctor. Timely elimination of violations will allow the patient to avoid the occurrence of anal fissure.
Anal fissure in a child - what is it?
An anal fissure in a child is a tear of the intestinal mucosa and the skin surrounding the anus. This phenomenon is especially common in preschool and primary school age - both girls and boys are equally affected by it.
In infants and preschoolers, this disease can begin with a small cleft with a bright red bottom and soft edges. In children prone to constipation, the size of such a tear will constantly grow both in length and in depth (in some cases it reaches 1.5-2 cm). It causes pain and great discomfort.
If treatment is not started on time, the crack will turn into erosion with rugged edges, and then grow into an ulcer. Sometimes the disease takes a chronic form with periodic exacerbations.
How to diagnose a crack?
Having noticed the smallest symptom, parents should urgently show the baby to the pediatrician or pediatric surgeon. Doctors will conduct a visual examination of the anus and perform a rectal palpation. In most cases, local anesthetics are used before these procedures.
You can also have a pre-medical examination at home. To do this, carefully spread the buttocks of the child to the sides and carefully inspect the anus. Remember, all other actions can only be carried out by a medical professional! This also applies to the appointment of drugs - self-medication is out of the question.
The use of candles - a powerful blow to the disease
To rectify damage to the mucous membrane of the anus, rectal suppositories for children with cracks will help. The following drugs are most effective:
- Glycerin candles. Once in the rectum, the components of these suppositories completely dissolve and envelop the mucous membrane. They soften feces and eliminate constipation, which prevents trauma to the walls of the intestine and promotes the rapid healing of cracks,
- Suppositories with calendula - eliminate the foci of inflammation, destroy pathogenic bacteria, relieve pain,
- Relief - contains shark liver oil, has immunomodulatory, anti-inflammatory and wound healing effects. Up to 12 years of age is appointed only in exceptional cases,
- Aurobin - designed to treat anus cracks in babies after 1 year. The composition of these suppositories includes analgesics that reduce pain. After the course of treatment, the elimination of itching and foci of inflammation is observed,
- Salofalk - used since 6 years old, have anti-inflammatory effect, do not contain hormones,
- Alginatol - accelerate cell regeneration, stop bleeding, eliminate inflammation. Use from an early age is allowed. Before the introduction of these candles, it is necessary to put a cleansing enema,
- Sea buckthorn candles for children with cracks - contribute to wound healing, stop bleeding, and eliminate inflammation. For infants, half of the suppository is enough, so cut it along.