Rectal Issues in Toddlers: Hemorrhoids or Fissures?

My two-year-and-two-month-old daughter has a lump around her anus that seems to be either hemorrhoids or an anal fissure?

Hello Doctor, my daughter is 2 years and 2 months old.
She has been experiencing constipation for more than 3-4 days at a time, and I'm unsure if it's due to excessive absorption or insufficient hydration.
The stool that comes out is about 3 cm in diameter, similar to that of an adult.
Even the softer stools are the same size, and sometimes the front part is hard while the back part is soft.
Additionally, there is some blood present.
During a health check when she was over 1 year old, the doctor mentioned that this could be anal fissures and prescribed Garamycin Cream for application.
Recently, although she has been having bowel movements within 2 days, the pain during defecation has eased.
However, I have noticed a 2 cm long round lump at the anus.
I'm unsure if this is hemorrhoids or a worsening of the anal fissure.
Should I first consult a pediatrician for a referral? Is my child old enough to undergo surgery to remove hemorrhoids, or is medication sufficient? She does not seem to be uncomfortable when she doesn't have a bowel movement.
Since we are currently abroad, it is inconvenient to see a doctor.
Is there any immediate danger or risk of worsening this condition?

Longfeng Tai Mami, 20~29 year old female. Ask Date: 2011/12/13

Dr. Xiao Kaiwen reply Pediatrics

The round, elongated lump is likely not an anal fissure; it may be caused by long-term friction resulting in an external hemorrhoid, or it could be soft tissue from inside the anus slightly protruding (it's difficult to say without seeing it).
It is recommended to consult a pediatric surgeon.
There should not be any immediate danger, and whether surgical intervention or topical medication is needed should be assessed by a physician.

Reply Date: 2011/12/13

More Info

When it comes to rectal issues in toddlers, particularly concerning symptoms like constipation, rectal bleeding, and the presence of lumps around the anus, it is essential to approach the situation with care and a thorough understanding of potential causes and treatments.
From your description, it seems your daughter has been experiencing significant constipation, which can lead to hard stools that may cause anal fissures (tears in the lining of the anus) and possibly hemorrhoids (swollen veins in the rectal area). The fact that you mentioned her stools being quite large and sometimes hard suggests that she may be straining during bowel movements, which is a common cause of both fissures and hemorrhoids in children.
The presence of blood during bowel movements is concerning and should not be overlooked. In many cases, if the blood is bright red and appears on the stool or toilet paper, it is often associated with fissures or hemorrhoids rather than more serious conditions. However, it is crucial to monitor the situation closely. If the bleeding persists or worsens, or if you notice any other concerning symptoms (such as significant pain, changes in appetite, or lethargy), it would be wise to seek medical attention as soon as possible.

Regarding the lump you described, which is about 2 cm in size, it could be a hemorrhoid or a thrombosed hemorrhoid (a hemorrhoid that has formed a blood clot), or it could be a skin tag resulting from previous fissures. In children, hemorrhoids are less common than in adults, but they can occur, especially if there is a history of constipation and straining.
As for treatment, it is essential to maintain a diet rich in fiber and ensure adequate hydration to help soften the stools. This can include fruits, vegetables, and whole grains. Additionally, over-the-counter stool softeners may be beneficial, but it is advisable to consult with a pediatrician before starting any medication.
Topical treatments, such as the Garamycin cream you mentioned, can help with pain and inflammation associated with fissures. However, if the lump persists or if there are signs of infection (such as increased redness, swelling, or discharge), it may require further evaluation by a healthcare professional.
In terms of surgical intervention, it is generally considered a last resort, especially in young children. Most cases of hemorrhoids and fissures can be managed effectively with conservative measures. Surgery is typically reserved for severe cases that do not respond to other treatments.
Since you are currently abroad and may have limited access to healthcare, I recommend reaching out to a local pediatrician or a gastroenterologist who specializes in pediatric care. They can provide a thorough examination and determine the best course of action.
In summary, while your daughter's symptoms may be manageable with dietary changes and topical treatments, it is essential to keep a close eye on her condition. If symptoms worsen or do not improve, seeking medical advice is crucial to ensure her health and well-being.

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