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Perianal appearances associated with constipation
U Agnarsson1, C Warde, G McCarthy
1Royal Alexandra Hospital for Sick Children, Brighton, East Sussex.
Insights
No single perianal sign definitively indicates childhood constipation. This study found fissures and anal dilatation in many children, but these signs often co-occurred with fecal loading or other perianal conditions.
Area of Science:
- Pediatrics
- Gastroenterology
- Dermatology
Background:
- Childhood constipation is a common condition.
- Perianal signs are often observed in constipated children.
- Standardization of examination techniques is lacking.
Purpose of the Study:
- To prospectively investigate perianal appearances in constipated children.
- To identify any pathognomonic signs of constipation in the perianal region.
- To assess the association between specific perianal signs and constipation severity.
Main Methods:
- Prospective study of 136 constipated children (mean age 3.9 years).
- Recorded perianal signs: anal dilatation, fissures, tags, warts, edema, redness, blueness, veins.
- Assessed anal dilatation timing and fecal loading.
- Correlated perianal signs with fecal loading and each other.
Main Results:
- Anal dilatation found in 18% of children, more common with fecal loading.
- Fissures observed in 26% and tags in 5%.
- Perianal redness associated with fissures; blueness associated with dilatation.
Conclusions:
- No single perianal sign is pathognomonic for childhood constipation.
- Fecal loading and other perianal signs frequently accompany observed findings.
- Standardization of the anal examination technique is recommended.
Abstract:
The perianal appearances were studied prospectively of 136 constipated children (mean age 3.9 years, 67 boys, 69 girls). Anal dilatation, fissures, tags, warts, perianal oedema, redness, blueness, and veins were recorded. It was noted whether dilatation occurred immediately or at 30 and 60 seconds with the buttocks minimally separated, and on subsequent firm lateral traction of the buttocks. The degree of faecal loading was assessed in all children. Anal dilatation was found in 24 (18%) and first appeared on lateral traction in eight (6%). In three quarters of the children with dilatation faecal loading or perianal signs were present. Fissures were found in 35 (26%) children and tags in seven (5%). Perianal redness was more likely to be associated with fissures, and blueness with dilatation. We conclude that there are no pathognomonic perianal signs in childhood constipation and that the technique of anal examination should be standardised.