Acquired anorectal disorders: Prolapse, fistula, and hemorrhoids

Acquired anorectal disorders in children include anal fissures, perianal abscess/fistula, hemorrhoids, and rectal prolapse. In general, fissures, hemorrhoids, and rectal prolapse are initially treated by attempting to normalize stooling. This is by dietary modification, stool softeners (e.g. Laxido, Movicol) and/or stimulant laxatives (e.g. senna). Although rectal prolapse is common and usually resolves spontaneously, in a proportion symptoms will persist despite normalization of stooling. Anal fistula is a communication between the perianal skin and the anal canal following perianal abscess. Fistulas are “low” in infants/children and usually pass straight between the skin sinus and the anal canal at the level of the dentate line. Presentation is with a perianal swelling, with bleeding, though itching and tenderness are also possible. This is often preceded by constipation with straining. The swelling is usually a small bluish/purple lump at the anal margin, rather than the more obvious prolapsing swellings seen in adults.