Fissures An anal fissure is probably the most common cause of bleeding, especially in infants However, fissures may occur at any age The child usually has a history of passing a large, hard stool with anal discomfort Often, the child has a history of chronic constipation with progressive reluctance to pass stool because of the associated discomfort If bleeding occurs, it usually involves streaking of bright red blood on the outside of the stool or red blood on the toilet tissues The diagnosis can easily be made by inspection or anoscopic examination and appropriate measures taken to relieve the chronic constipation (see Chapter 18 Constipation ) Rarely does a child require hospitalization or surgery Juvenile Polyps Older infants and children can develop either single or multiple retention polyps Usually, the polyps occur in the lower portion of the colon and can often be palpated on rectal examination Polyps bleed, but they rarely cause massive hemorrhage They may intermittently prolapse at the anus or on occasion come free and be passed as a fecal mass associated with bleeding Colonic polyps may be lead points for intussusception Usually, however, polyps are asymptomatic except for the associated bleeding These are not premalignant lesions, and they tend to be self-limiting ( Fig 116.18 ) although they can be easily removed by colonoscopy