These are usually due to a child passing a hard bowel motion at some point and tearing the delicate anal margin and because faeces is passed through this area continuously it is often difficult for this to heal. Anal fissures can occur causing painful defecation and some blood which is usually bright red and usually coating the faeces. They are often associated with constipation and sometimes associated with infections in this region due to the bacteria that causes sore throats, streptococcus. In this circumstance treatment with antibiotics is effective. In other situations a simple anal fissure will resolve if the faeces are kept soft with laxatives and if local pain relief is applied with ointments. An increase in blood flow to the anal area for healing of the fissure may also help with a special type of paste. A significant portion of anal fissures are due to cow’s milk protein allergy and can resolve with removal of dairy produce in a strict fashion with the input of a Paediatric Dietitian and a Paediatrician.