🩺 Section 392.2: Anal Fissure

Nelson Textbook of Pediatrics 22nd Edition — Anal fissure is a linear tear in the anal mucosa, most common in infants. Presents with pain on defecation (crying, screaming) and bright red blood on the surface of the stool. Diagnosis by inspection (posterior midline fissure). Treatment: stool softeners (PEG 3350), increased fluids, sitz baths. Chronic fissures: topical nifedipine or nitroglycerin. Surgery rarely needed.

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📋 30 Clinical Scenarios — Anal Fissure

📇 High‑Yield Review Cards (Anal Fissure)

🩺 Clinical Presentations: Anal Fissure

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation & Management of Anal Fissure

🔑 Key Principles — Anal Fissure (Nelson 392.2)
• Cause: Constipation with hard, large stool causes tearing of anal mucosa (usually posterior midline).
• Clinical: Sharp pain with defecation (infant cries, arches back), bright red blood on stool surface.
• Diagnosis: Inspection (gentle separation of buttocks) reveals a linear tear, often with a sentinel skin tag.
• Treatment: Stool softeners (PEG 3350), increased fluids, sitz baths. Chronic fissure (>6 weeks): topical nifedipine or nitroglycerin.
• Surgery: Internal sphincterotomy reserved for refractory cases (rare in children).

    ⚡ Reflex Prompts — Anal Fissure

    📖 Anal Fissure — Core Summary (Nelson 392.2)