Although it can be seen in all ages in childhood, it is observed much more frequently between 6-24 months. It is seen equally in both sexes. Although it is thought that the causes of anal fissure in children, constipation and straining during defecation, anatomical factors (the rectum has not yet taken the “S” shape), causes of inflammation in the anorectal region, especially inflammatory bowel diseases, long-term diarrhea and finally, it is rare in our country. It can also be listed as sexual coercion.
The clinical manifestation of anal fissure is blood on the stool and painful defecation. Anal fissure is really an important disorder that can disrupt the physical and mental health of the child and even his family. If the fissure does not heal within 4-6 weeks or is resistant to treatment, it is considered as a chronic fissure. Acute fissures are ulcers with sharp, linear or pear-shaped borders, which may have granulation tissue at the base, extending from the linea dentate (the toothed line separating the upper two-thirds of the anal canal from the lower third) to the rim of the anus. Although clinically, there is no definite definition to distinguish between acute and chronic fissures, fissures that do not heal spontaneously or with dietary methods 4-6 weeks after diagnosis are considered chronic.
Although the theory that solid stool causes direct trauma to the least resistant region of the posterior wall during the passage through the anal canal seems plausible, the fact that a significant portion of the cases with anal fissures do not have constipation or even diarrhea makes this theory insufficient. . After the anal fissure is formed, patients’ avoiding defecation for fear of pain undoubtedly causes hardening of the stool.
Investigations in cases with anal fissures revealed excessive activity in the internal anal sphincter and an elevated resting anal pressure. This sphincteric spasm creates a vicious circle of anal pain – fear of defecation – solid stool passage that further stimulates internal sphincter activity. Today, the basis of anal fissure treatment is to break this cycle with medical or surgical methods. One of the two most important factors in the formation of anal fissure is the high resting pressure in the anal sphincter. It has been shown that this pressure can be removed temporarily with medical treatment and permanently with surgical treatment, and the region with the highest pressure is the posterior wall.
In medical treatment, warm sitz baths, analgesics (primarily local analgesics), stool softeners, and a high-fibre diet are always necessary treatments. For most acute fissures, it may be sufficient on its own. In chronic cases, it is a factor that makes life easier. It can eliminate sphincter spasm, albeit temporarily and for a short time.
While surgical interventions in the treatment of anal fissures are a frequently used concept in the adult age group, there is little experience in this regard in children. The main methods used are; fissurectomy, anal dilatation, sphincterotomy procedures and anoplasty.
