Anal Fissure in Children
A child crying, refusing to sit, or holding in stool because bowel movements hurt is one of the more common reasons parents search for anorectal symptoms — and an anal fissure, not a hemorrhoid, is usually the answer. Hemorrhoids are uncommon in children; fissures are not.
- Anal fissures in children are usually caused by passing a hard or large stool, most often related to constipation.
- Symptoms include pain during and after bowel movements and small amounts of bright red blood on the stool or toilet paper.
- Most fissures in children heal with simple measures — more fiber and fluids, and sometimes a stool softener — within a few days to weeks.
- Fissures don’t cause colon cancer and don’t lead to other serious long-term problems, but blood mixed into the stool, or a fissure that doesn’t heal, is worth discussing with a pediatrician.
Why this happens
A fissure is a small tear in the lining of the anal canal, and in children it almost always follows the same basic pattern seen in adults: a hard or large stool stretches and tears the tissue during passage. Constipation is the most common underlying driver — sometimes from diet, sometimes from a child voluntarily holding stool (often because an earlier bowel movement hurt, creating a cycle of holding → harder stool → more pain).
Symptoms to look for
- Pain during and for some time after a bowel movement — a young child may cry, resist sitting on the toilet, or arch their back during a bowel movement
- Bright red blood, usually a small amount, on the stool surface or on toilet paper
- Visible straining or reluctance to have a bowel movement at all (stool-holding behavior)
- A visible tear or skin crack may sometimes be seen on gentle examination, though parents aren’t expected to identify this themselves
What to do at home
Most childhood fissures heal with the same basic approach used in adults:
- Increasing fiber and fluid intake to soften stool
- A pediatrician-recommended stool softener if dietary changes aren’t enough on their own
- Warm sitz baths, a few minutes at a time, a few times a day and after bowel movements, which can ease pain and support healing
- Avoiding a cycle of stool-holding by treating the underlying constipation, not just the pain
Most fissures improve within days to a few weeks with this approach.
When it doesn’t resolve, or looks unusual
- A fissure that hasn’t improved after a couple of weeks of consistent home care may need medication (similar topical options used in adults) or, rarely, a procedure — this is a conversation for a pediatrician, not something to manage indefinitely at home.
- Fissures that are recurrent, unusually located, or don’t fit the typical picture are occasionally associated with other underlying conditions and warrant a closer look by a pediatrician.
- Any blood mixed into the stool (rather than just on the surface) is worth mentioning specifically, as this pattern is less typical for a simple fissure.
A reassuring note
Anal fissures don’t cause colon cancer in children and don’t lead to other serious long-term complications on their own. The main goal of treatment is comfort and breaking any stool-holding cycle before it worsens the underlying constipation.
When to see a pediatrician
- Pain with bowel movements lasting more than a few days despite home care
- Any blood mixed into the stool, not just on the surface
- Fissures that keep recurring
- Significant stool-holding behavior, which can become its own problem if not addressed
This page is for general education and isn’t a substitute for a pediatrician’s evaluation.