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Anal Problems

By far the most alarming anal problemin infants and children is bleeding, and the most com-mon cause of bleeding in this area is a fissure, a crack ortear in the sensitive skin of the anal opening. Fissures arenearly always caused by the passage of a hard stool, al-though scratching or sometimes irritation fromcleansers in baby wipes can promote the formation offissures. Typically the blood appears as a streak on thestool, and it may not be present the next time the bowelsmove. If blood actually flows after a stool, it will usuallystop on its own in five to ten minutes.

Treatment involves eliminating any underlying causeof she fissure, d cossible, sauce masbc all will heak usitheir own if they are not continually irritated. If stoolsare hard, increased amounts of fluid, dietary fiber (fromfruit, vegetables, and bran), a mild stool softener, or even mineral oil may be helpful, depending upon the age of the child (see constipation). Multiple fissures and in-flamed tissues may improve with warm soaks and theuse of a mild cortisone cream. If there are other con-tributing factors such as infection or pinworms (see be-low), these should be treated. Your child's health-camprovider should give you input in the diagnosis are:management of this problem.

Hemorrhoids are dilated veins in the anal area thancan bleed, itch, or clot. They are extremely uncommonin infants and children, and if discovered, a cause shouidbe sought. While prolonged constipation and strainingmay be the cause, abnormalities in the venous system.which returns blood to the heart, must be considered.Anal itching can be caused by irritated skin, a fissure.soaps and cleansers, or pinworms. If you discover voxchild intensely scratching this area during the night, pin-worms might be the cause (see pinworms). A local inf-tion involving the common yeast Candida albicansbe treated with antifungal cream. Occasionally a chidwith a bacterial infection in the nose will accidentaisttransfer the bacteria to the anal area.

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