Seeing bright red blood on the toilet paper or on the surface of a stool is alarming. When there is no diarrhea, a small tear in the skin around the anus, called an anal fissure, is the most common cause. This article covers why it happens, what helps at home and which signs call for a visit.
Why It Happens
The American Academy of Pediatrics (HealthyChildren.org) symptom guidance explains that a fissure usually results from passing a large or hard stool, and that it accounts for about 90% of children with blood in the stool. Seattle Children’s reports the same figure. The blood is typically bright red, sits on the outside of the stool or on the tissue, and is small in amount; a few streaks can turn toilet water pink without meaning a large loss. Because a tear hurts, children often hold stool back, which makes the next stool harder and can tear the skin again.
How It Differs by Age and Stage
In infants, firmer stools after a formula change or the start of solid foods can lead to a fissure. Toddlers learning to use the toilet commonly withhold stool, and school-age children may put off bathroom visits. Blood together with diarrhea, or in a child who looks ill, points to causes other than a fissure, so it should not be assumed to be one.
What to Do at Home
HealthyChildren.org’s symptom guidance describes sitting in a warm water bath for about 20 minutes as a way to ease discomfort. Softer stools are the core of treatment: for children over 1 year, fiber from vegetables, fruit and whole grains plus plenty of water may help. If constipation is already present, the AAP constipation guidance describes stool softeners, and the dose should be set with the child’s doctor rather than guessed. After a bowel movement, rinse with lukewarm water and pat dry instead of wiping hard. Sitting on the toilet for about 10 minutes after meals can help build a routine, and calm encouragement matters when a child is afraid of pain.
Common Misunderstandings
Many parents assume any rectal blood means hemorrhoids, but in children a fissure is far more common. Some cut back on food or discourage stooling to protect the area, which can make stools harder. Others stop fiber and fluids once it heals, and the fissure returns when stools firm up again. Finally, redness and soreness around the anus can come from a skin infection, which can also cause blood-streaked stool and needs a clinician’s check.
When to Seek Care
The AAP symptom guidance advises calling the doctor within 24 hours for a small amount of blood with no other symptoms, and saving the stained tissue or diaper for the visit. Same-day care is advised for black or tarry stool, blood with diarrhea, pink or tea-colored urine, belly pain, unexplained bruising, or any blood in a baby under 12 weeks old. Go to the emergency room right away if there is heavy bleeding or the child looks pale, limp or faint. A fissure that has not healed after about 2 weeks or keeps returning also deserves an evaluation. This information is based on U.S. sources; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.