Anal fissures and anal scars in anal abuse?are they significant?

Abstract

The notes of 214 children who, over a period of 7 years, had been referred after an allegation or a suspicion of any form of child abuse, were examined retrospectively to establish the pattern of injury found, especially with regard to anal fissures or scars. These were all children who had had their genitalia examined at the time of their referral. In 81 children (Group A) who had no history or evidence of sexual abuse, two fissures were found, both with medical explanations for their presence. In 83 (Group B) who alleged sexual abuse but denied anal abuse, nine (11%) had fissures or scars, and in four of the nine there was a history of significant constipation at some time. In 50 children (Group C) who had a strong history of anal abuse, 41 (84%) had fissures or scars. The diagnosis in 13 of these cases was considered definite because there was a confession or guilty plea from the abuser; in the remainder, the diagnosis was "not proven" despite a strong history or gross anal signs and regardless of the verdict in court proceedings. The significance of the findings was discussed with a view to clarifying the relative importance of anal fissures in children with a strong history of anal abuse.

Functional Fecal Incontinence in Children

“…It is important to consider the possibility of sexual abuse if anal fissures and scars are found upon examination without evidence of a medical cause for these abnormalities. These anal findings are reported to be significantly more present in children with a history of anal sexual abuse [31,32] . Anorectal digital examination assesses perianal sensation, anal tone, size of the rectum, amount and consistency of stool in the rectum, voluntary contraction and relaxation of the anal sphincter, and the presence of an anocutaneous reflex (anal wink).…”

Incontinence fécale fonctionnelle chez l’enfant

“…Il est important d'envisager la possibilité d'abus sexuel en cas de présence de fissures et cicatrices anales à l'examen sans signe de cause médicale de ces anomalies. Ces observations anales sont significativement plus présentes chez les enfants ayant des antécé-dents d'abus sexuel anal [31,32] . Un toucher rectal évalue la sensation périanale, le tonus anal, la taille du rectum, la quantité et la consistance des selles dans celui-ci, la contraction volontaire et la relaxation du sphincter anal et la présence d'un réflexe anocutané (clignement anal).…”

Incontinencia fecal funcional en niños

“…Es importante considerar la posibilidad de abuso sexual si se hallan fisuras y cicatrices anales en el momento de la exploración en ausencia de indicios que expliquen una causa médica de estas anomalías. Se ha descrito que estos signos anales son significativamente más abundantes en niños con antecedentes de abuso sexual anal [31,32] . El tacto anorrectal evalúa la sensación perianal, el tono anal, el tamaño del recto, la cantidad y consistencia de las heces en el recto, la contracción y la relajación voluntarias del esfínter anal y la presencia de un reflejo anocutáneo (espasmo anal).…”