Everyone knows that bloody stools are not normal and a cause of concern. However, one common cause, anal fissures, may be something you can diagnose on your own and not require medical intervention. As miserable as anal fissures are, they are the lesser of the evils when it comes to causes of bloody stools.
What are anal fissures?
An anal fissure is a small crack or tear in the skin surrounding the anus (the actual hole in the butt). If deep or big enough, anal fissures can have bleeding with them.
How can I tell if my child has an anal fissure?
The tissue around the anus is naturally puckered and a dark pink color. To evaluate for an anal fissure, you must get the anus to spread out enough to see if there are any small tears amid the creased skin. To do this you can either have your child “bear down” (push like he/she is going to go poop) or manually pull the skin apart. With anal fissures, there is usually not active bleeding, but rather a small break in the skin.
What causes anal fissures?
Almost all cases of anal fissures happen from significant constipation. If a child is pushing a large rock of stool out of a tiny hole, the tissue will tear to allow the hard stool out. Most cases happen in children who are chronically constipated; although, it can happen with one large, bulky stool.
How do I treat it?
Getting anal fissures to heal can be really difficult. Imagine if you had a cut on your arm and in the process of trying to get it to heal, you rubbed a rock covered in feces over the cut every day. No wonder it can take a long time to heal.
- Treat the underlying constipation first. I usually recommend a daily laxative or stool softener (like Miralax). If soft stools can be reliably achieved with more natural approaches (e.g., juice, probiotics, diet changes/increase fiber), then that is preferable. The key here is to ensure that the stools continue to stay soft for a long time (months). If you manage to get the stool soft for weeks, but then have one hard stool, the tissue can easily re-tear and undo all the progress toward healing that was previously made.
- Heal the wound. I often will treat anal fissures with antibiotic ointments. Poop has natural bacteria in it and isn’t good for any wound. If your doctor doesn’t think an antibiotic ointment is warranted, then he or she may just have you use a protective barrier cream (like a diaper cream or Vaseline).
- Careful wiping. I usually recommend using some of those flushable, wet wipes to clean the anus after stooling. A piece of dry toilet paper is rough on the skin and doesn’t allow for as complete a cleaning job.
Anal fissures are miserable and can make a child very irritable, especially when it comes time to poop. If you have concerns, please talk to your doctor.