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Child suffering from constipation, complaining rectal pain, applied ointment. Relief with enigma. Treatment required?

Hi, doctor My daughter is 6 and half years old and she had constipation last week and she tried hard to pass tool and she did once but after that she started complaining about rectal pain so i took her to my family doctor and she suggested me some ointment believing she have resis in her rectal inner area. i applied that for almost 5 days and during these days she didnt go to washroom even she was passing urine only once a day and she was not eating properly due to pain. Finally i took her to the emergency department of nearest hospital and they gave her ENIGMA and finally she felt relief but today is next day of ENIGMA and she was complaining me this morning about little pain in anal. Can you please advise me it may happen after taking ENIGMA or it could be something else still needs to be checked and treated?
Asked On : Fri, 8 Feb 2013
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Pediatrician 's  Response
Thanks your your query.
She has developed anal fissure secondary to constipation & after enema simply the pain has returned because anal fiisure takes few weeks to heal provided the stools are kept soft during that period . Do not think of "anything else" at this stage.
An anal fissure is a small tear in the thin, inner lining of the anus. an anal fissure may occur when you pass hard or large stools during a bowel movement. anal fissures typically cause pain and bleeding with bowel movement. Anal fissures are painful and may cause your child to resist going to the toilet (or holding on). A vicious cycle can then set up with holding on making constipation worse and subsequent bowel movements more painful to pass.
Increase her fluid & fibre intake. ask your GP for stool softeners which need to be continued for 4-6 weeks as a minimum . By then anal fissure will get healed & her eating & toileting habits can be changed positively.
Hope you find the information useful.
Answered: Sat, 30 Mar 2013
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