Anal Fissure in Children

Navigating the complex terrain of childhood sexual assault allegations: Mimics of sexual assault in the paediatric population

Reports of sexual assault are inherently distressing for all parties involved, and this emotional burden intensifies when the victim is a child. Encountering a potential case of sexual assault, coupled with the complexity of childhood memory and communication, creates a challenging diagnostic landscape. Untrained or inexperienced physicians may misdiagnose or over-diagnose cases of childhood sexual assault, inadvertently triggering a cascade of mental and emotional distress for all parties involved. This paper examines the mimics of sexual assault. It sheds light on the critical need for sensitivity, education, and support for healthcare professionals and their patients when dealing with childhood sexual assault allegations, ultimately aiming to reduce the risk of misdiagnosis and the emotional anguish that can follow. In addition, with the greater than 10-year backlog in sexual assault cases waiting to be tried in Barbados, the child may be an adult by the time a trial occurs and this skews the process.

Effects of neuromodulation on treatment of recurrent anal fissure: A systematic review

BACKGROUND

Anal fissure is a linear tear in the distal anoderm most frequently occurring in the posterior midline. Lateral internal sphincterotomy is considered the gold standard for the treatment of this condition. To this date, several pharmacological and neuromodulatory therapies have been tried out as alternative non-invasive treatments for anal fissures, however, the efficacy of some of these methods remains to be understood.

OBJECTIVE

the primary aim of this study was to review available literature on neuromodulatory treatments for recurrent anal fissure as a potentially effective cure for this condition.

DATA SOURCES

A search was conducted among five main online databases Embase, PubMed, Web of Science, Scopus, and Scholar.

STUDY SELECTION

All published human studies in English literature addressing neuromodulation for the treatment of recurrent anal fissure were selected.

INTERVENTION

neuromodulation for the treatment of anal fissure. We chose to include all articles in which the authors stated that the procedure they performed was via neuromodulation technique, or that the described technique used in their study resembled the technique.

RESULT

Among a total of 3487 evaluated studies, seven represented the effects of neuro modulation on treatment of recurrent anal fissure, among which two were randomized controlled trials and the rest were prospective studies. A total of 186 patient were evaluated in these studies. The mean age of the participants was 46.97 ± 8.2. The average VAS score before intervention was 7.77 ± 2.13, which decreased to 0.31 ± 1.13 after intervention.

LIMITATIONS

limitations of this study include the lack of related articles, and data regarding this subject.

CONCLUSION

Posterior tibial nerve stimulation (PTNS) provides rapid pain relief and fissure healing especially in short-to mid-terms with little to no complications, however, using this treatment, symptoms of anal fissure do not improve as well as LIS, especially in the long-term.