ANAL FISSURE IN CHILDREN – A PEDIATRIC OR SURGICAL PROBLEM?

Abstract

An anal fissure is the commonest disease of the anal canal in children, and their suffering and poor quality of life determine the feasibility of the present study. Objective is to determine the main causes of anal fissure development in children as a joint paediatric and surgical problem, for their adequate treatment in order to improve the quality of life. Material and methods. The study included 64 children with anal fissures who were observed at the Kyiv City Children’s Clinical Hospital No. 1; 39 (60.9%) boys and 25 (39.1%) girls. All children underwent a complete clinical, laboratory and instrumental examination. Results of the study. There were 7 (10.9%) children under 3 years old, 27 (42.2%) – from 3 to 6 years, 16 (25.0%) – from 7 to 10 years, 9 (14.1%) – from 11 to 14 years, and 5 (7.8%) – from 15 to 18 years old. The course of the disease in 26 (40.6%) patients within 2 to 3 months led to constipation. Localization of the anal fissure (fissure in the posterior anodermis at 600 position in 55 (85.9±4.4)% patients, and combined fissures at 600 and 1200 position in 9 (14.1±4.4)% children. In all patients, the fissure occurred at the background of constipation. The treatment was complex: elimination of sphincter spasm and hypertonia of the internal anal sphincter, and administration of lactulose-containing medications. Individualised treatment methods had a good result in 100% of cases, and there were no indications for surgical anal fissure excision. Conclusions. The main thing in the treatment of the anal fissure is its prevention. Delayed bowel movements lead to constipation and anal fissure. The examination should be comprehensive, and the treatment should include relief of spasm and pain during bowel movements, normalisation of bowel movements using lactulose-containing drugs and diet correction, which is aimed at preventing both constipation and anal fissure.