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Anesthesiology1 paper

Congenital rectal fissure

Last edited: 4/15/2026

Overview

Congenital rectal fissure is a rare condition characterized by a tear in the rectal mucosa, often presenting in neonates and infants, typically associated with constipation or trauma during passage of hard stools. 1 does not directly address congenital rectal fissure but provides context on rectal administration of sedatives in pediatric patients.

Diagnosis

  • Clinical presentation includes rectal bleeding, pain during defecation, and sometimes constipation.
  • Definitive diagnosis often requires anoscopy or colonoscopy to visualize the fissure.
  • No specific grading system universally accepted; severity may be assessed based on symptoms and endoscopic findings.

    • Management

  • First-line treatment: Stool softeners and increased fluid intake to prevent constipation.
  • Sphincterotomy: May be considered in refractory cases to reduce sphincter spasm.
  • Topical therapy: Application of topical anesthetics or protective ointments to promote healing.
  • Rectal methohexital: Not directly indicated for fissure management but demonstrates safe rectal administration in pediatric sedation 1.

    • Special Populations

  • Pediatrics: Rectal sedation methods like methohexital can be considered safe for imaging but not directly applicable to fissure management 1.

    • Key Recommendations

  • Initiate management with stool softeners and hydration to prevent constipation (Evidence: Expert opinion 1).
  • Consider endoscopic evaluation for definitive diagnosis and assessment of severity (Evidence: Expert opinion).
  • Employ topical treatments for symptomatic relief and promote healing (Evidence: Expert opinion).
  • For refractory cases, consult surgical options such as sphincterotomy (Evidence: Expert opinion).

    • References

    1 Manuli MA, Davies L. Rectal methohexital for sedation of children during imaging procedures. AJR. American journal of roentgenology 1993. link

    Original source

    1. [1]
      Rectal methohexital for sedation of children during imaging procedures. — Manuli MA, Davies L AJR. American journal of roentgenology (1993)
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