Anal fissures in children -Anybody know anything?

[SparkleRainbow]

My four year old has a possible diagnosis of anal fissures, which may be what is causing her extreme pain. Does anyone have any experience of this with their dc, any possible home cures or ideas to ease her pain before we get the referral appointment?

Poor thing so painful and can set up dreadful refusal to poo and increasing constipation - leading to increasing pain, refusal to poo, and so on....
Its absolutely vital to keep the poo as soft as possible, but not loose, (loose is irritant) diet, fruit, vedge, plenty of water/fluids. Can your GP prescribe a suppository to soothe the area similar to heamorrhoid supps for adults.?

My DGD had trouble with this. Diet as beammeupscotty said. The GP gave her suppositories to soften her stools and allow healing. They are inserted when she felt the urge to go.

My dd had this for about 18 months, starting when she was just under 2. It was hell. What I found was that it was a vicious circle: pain on pooing meant that dd held in the next poo, usually for days, and then when she couldn't hold it in any longer, she would lie on the floor and scream until she was done. Then the cycle would begin again. The only thing that worked in the end were glycerine suppositories. They make the child go straightaway and lubricate the passage to make it less painful so that the fissure can heal and the child gradually stops associating pooing with pain. Good luck.

Thank you all for your replies. At the moment the gp has given us nothing, but is making a referral to a paediatrician. She will drink gallons of milk, and some water, nothing else. It is interesting to hear from you that loose stools are an irritant because so far her worst attacks of pain have been when she has been loose rather than constipated. She has a pretty good diet of veg and fruit, wholegrain cereal every day, brown bread etc. May be it is the water I need to up the quantities of? Do you think vaseline would help when she is having a bad time with it? So far all I have been able to do is give her pain killers and put nappy cream around her anus (more placebo than anything!)

DD1 had this earlier in the year when she just turned 3. It's miserable and the vicious cycle is true.

I wonder why your gp hasn't given anything, is there concern about anything else?

Our gp was great, talked diet and drinking lots of liquid. She prescribed lactulose (laxative) which DD ended up taking 3 times a day (5ml per dose) to get her poo soft enough to not be able to hold it in for days and also soft enough that the sphincter didn't need to open too much (thus reopening the cut).

Also got dermol on prescription for dd to wash her bottom with in the bath as it was sore. And was told to use calpol if that helped.

It took about 2 months for the psychological fear to go and we've only just stopped the laxative as she was still holding poo (but by then the cut had had time to heal but she was just scared, holding it in and risking another cut/reopening the cut each time). I hope your dd feels better soon.

Interestingly, the gp spoke to paediatricians at the hospital who said they would only go the route of suppositories if absolutley necessary (if the lactulose hadn't worked) as they find anything which requires you to touch/apply medicine to the bottom area just added to the psychological stress (ie made the child more afraid of pooing/made a bigger deal of it somehow). Lucky for us the lactulose worked and we didn't need referral.

Thanks Norkily, no there are no concerns about anything else. He just said he would not examine her as it would just be distressing for her, and he would make the referral to the paeds. They are normally fansastic at the gp's and I can go back easily to check things with him, so I think I will do that.

Dd is not holding poo yet, but she is frightened to go and asks me to come with her and hold her hand when she goes. I try to distract her, and talk about what we will go and do when she has finished, and that works sometimes, but others the pain is so bad she is inconsolable. She is most frightened about loose stools unfortunately/weirdly, as I think they sting more. Poor little thing she is really miserable with it. When she cried in her sleep because it is hurting it just breaks my heart that I can't do more.

We had lots of chat about how you have to push the naughty poo out and the medicine (lactulose) would help make her poo soft and I think talking about it did help DD1. GP recommended stickers or rewards for poo if it was bad.

Your poor dd. I would be tempted to ask about it, but then if she has loose poo already maybe they don't want to risk making it even looser? We gradually worked our way up in 5ml doses to 3 per day until she was pooing once a day.

It's really horrible isn't it?

It really is, she isn't at school today because she is so tired after having had an other bad night with it. She tends to need to do a poo in the late afternoon/early evening, and then we have tears for ages afterwards because it hurts so much. She didn't wake up until gone 9 am today, poor little girl.

Lactulose you can buy over the counter, and that helps if your Dd is constipated, but otherwise he doctor can prescribe a steroid cream which will numb the pain and help with the healing. Dr gave it for my 3yr old and it cleared up after a couple of weeks. Hth.

Personally, I would recommend Movicol - we used lactulose for a long time and found it hard to give to DD2, and also it didn't seem to work too well. When she started having movicol, it was easy to give to her (just put it in her juice or milk), and apparently it does something to the bowels that gets them going, as well as softening the stool.

HTH

Helokitty - without being too graphic as I am about to serve up dinner for the kids, how do you apply the steroid cream to the affected area? Do you get an applicator like you can for anusol.....way to much knowledge about that since third child.....sorry everyone!

Sorry, the doctor didn't give me one - I just had to use my finger (oh the things we do for our chdren!). I was told to get her to strain slightly (to open up the anus) and apply 5 mins before she did a poo. It healed her fissures within about 2 weeks. She is 3 btw. Hth

Thanks for that,I suspected that would be the way to apply it! I am going to have a chat with the gp about it next week.