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Eur J Pediatr Surg 2020; 30(05): 391-394
DOI: 10.1055/s-0040-1716723
Review Article

Anal Fissure in Children

Barbora Patkova
1   Department of Pediatric Surgery, Uppsala University Hospital, Uppsala, Sweden
2   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
,
Tomas Wester
2   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
3   Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
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Abstract

Anal fissure is a common clinical problem in children and is defined as a longitudinal tear in the anal canal. The typical presentation is painful defecation and rectal bleeding. The etiology of anal fissure is unknown, but passage of hard stools and increased internal anal sphincter pressure are considered important factors. The treatment is oriented to relieve the spasm of the internal anal sphincter, which prevents healing of the fissure. Conservative management with stool softeners, topical analgesics, and sitz baths is recommended as first-choice therapy. Surgical treatment has been replaced by nonoperative management as definitive therapy, which is associated with a marginally higher success rate than placebo. Most recent studies have focused on nonoperative treatment with glyceryl trinitrate, calcium channel blockers, or botulinum toxin injection treatment. There are a few controlled studies to compare the different nonoperative treatment options in children. Success rates vary between the studies, and there is no clear evidence about which is the optimal nonoperative treatment. A significant recurrence rate has been reported after nonoperative management of anal fissure. It is important to treat constipation to avoid recurrent tears in the anal canal.

Keywords

anal fissure - children - glyceryl trinitrate - diltiazem - botulinum toxin


Publication History

Received: 16 July 2020

Accepted: 16 August 2020

Article published online:
13 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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