Introduction

Anal fissures are among the most common anorectal conditions in children, defined as a linear or oval tear in the squamous epithelium (anoderm) of the distal anal canal, below the dentate line [1][2]. They represent a significant source of pain, rectal bleeding, and stool-withholding behavior in children. Unlike adult fissures, the vast majority of fissures in children respond to treatment of the underlying constipation alone — a finding confirmed by a prospective, double-blind RCT demonstrating that polyethylene glycol (PEG) alone yielded equivalent symptom resolution compared to PEG plus topical diltiazem in children ≤14 years [3]. This underscores that chronic, surgically refractory fissures are comparatively rare in the pediatric population.

content in this topic is referenced in SCORE AnalPathology: Fissures, Abscesses, Fistulae, Pilonidal, Prolapse overview