Anal fissures are one of the commonest diseases affectingthe anus and causes of pain and lower gastrointestinal bleeding in children. It is a painful tear located at the entrance to the anus. Although the true cause is not completely known, its symptoms are very well known, which are characteristic and help makethe diagnosis.



It is located in the anus, below the dentate line, usually at 6 o’clock, or at 12 o’clock, when the patient is examined inthelithotomyposition. Its length is fixed and extends from the dentate line to the entrance of the anus and is oval shaped.


The cause of anal fissure is not completely known. The main cause in neonates, infants and children is the injury of the anal canal by the passage of hard stools (constipation), with diarrhea, orvery rarely it can be due to inflammatory diseases of the colon, granulomatous diseases, (tuberculosis, sarcoidosis) or malignancies (leukemia).


The symptoms of anal fissures are typical. The main symptom is acute pain that occurs during or after thepassage of stool. Bleedingis quite common, and is usuallya small amount of bright red blood staing the stool, toilet paper or basin. Examinationis important to identify the presence ofanal fissures. Usually at 6 o’clock, towards the coccyx, the tip of the fissure appears, which always extends steadily from the entrance of the anus to the dentate line.The differential diagnosis includes inflammatory bowel disease (Crohn’s disease, ulcerative colitis), hemorrhoids, angiodysplasia, bowel duplication, polyps and other causes of lower gastrointestinal bleeding in children.


The treatment is mainly conservative, by treating the underlying cause, good hygiene and the use of creams with a local anesthetic to relieve pain.