OCCASIONALLY in the practice of pediatrics, a mother will bring in a child with a complaint of painful defecation. This symptom is often accompanied by soiling and anal soreness with secondary constipation. In time anal abrasions or small fissures occur which cause more pain, and a vicious cycle of events has become established. Anal erythema or soreness not associated with diaper rash is seldom mentioned in the pediatric literature. Treatment of these patients by general practitioners, pediatricians, or proctologists has been empirical and symptomatic, usually consisting of local ointments and stool-softening adjuvants.
We have been impressed that some of these children show a pronounced erythema of the tissue surrounding the anal orifice (Fig 1), and that palpation in this area with the gloved finger discloses a somewhat boggy consistency and also causes discomfort to the child. Since, in one of these children, a cotton swab rubbed over the lesion and