Acquired anorectal disorders

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Anal fissure is the most common cause of minor rectal bleeding in infants and toddlers, and is associated with constipation and painful defaecation. The tear in the anal mucosa is typically located in the posterior midline. Chronic fissure is sometimes associated with a sentinel skin tag at 12 o'clock position. Treatment consists of stool softener, sitz bath and local anaesthetic gel application. Occasionally a chronic fissure requires topical nitroglycerin therapy or lateral sphincterotomy. Rarely, Crohn's disease and immunodeficiency can present with laterally located anal fissures.

Rectal polyp causes painless rectal bleeding in school aged children. The juvenile polyp is a harmatoma and sometimes autoamputate. A rectal polyp which persists can be removed endoscopically with a diathermy snare. More than one polyp may be found in up to 25 % of patients upon colonoscopic examination. The condition is benign and should be distinguished from diffuse adenomatous polyposis in Peutz-Jeghers syndrome and familial polyposis coli.

Perianal abscess occurs commonly in infants and is treated by incision and drainage. Approximately one third of abscesses develop into a fistula-in-ano. Fistulas which persist after infancy are treated by fistulectomy. Crohn's disease should be considered in older children with multiple fistulas.

Rectal prolapse usually occurs in the toilet training age group and is often associated with constipation. The prolapse usually involves the mucosa only and responds to conservative treatment. Persistent prolapse may require hypertonic saline injection or Thiersch procedure using a strong nylon suture. The possibility of cystic fibrosis should be considered.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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