<human>: Hi my 5 years old child has big problems when ever he wants to go to toilet. He told me that he has pains when the stool comes out. Most of the time he prefers to start his kaka on his pants and he goes to toilet. Yesterday I saw that he has very inflamated anus, what would be the cause and solution for this problem. Thanks
<bot>: Hello and welcome to Chat Doctor. Painful defecation and sore anus may be due to following reasonsAnal fissures:Prolonged constipation and straining can cut the anal skin leading to anal fissures which is a very painful condition and can exacerbate the situation by creating fear of defecation and retention which lead to leaking stools and soiled pants. To rule out this condition he needs to be examined by pediatric surgeon. I advise Xylocaine gel, sitz baths and stool softener in such situations.  Pin worms:They irritate TH sensitive skin moreover itching can also lead to raw skin. Contact of stools with raw skin will hurt a lot specially if the stools are hard. Local examination, Stools inspection and stool routine examination will confirm the diagnosis. I prescribe zinc oxide cream and Albendazole syrup in such situations. Food allergy:It makes the stool acidic which irritates the skin and similar condition develop as in pin worms only that acidic stools will burn the skin more. Stool test for reducing sugars can confirm the diagnosis. Zinc oxide cream and omitting the alleged food will be my advice in such situation.4th Condition which is very sensitive and grave matter both for you and us(your treating team) that is sexual abuse must be kept in mind. It can lead to sore/inflamed anus and fear of Defecation. AND you MUST be very vigilant to keep an eye and must INTERVENE if such situation is possible. Hope you find this answer helpful. Good luck!