The Forensic Nurse

Canada recently updated its laws concerning the age of sexual consent this may. The laws are being rewriten to bump that age by two full years.

Under the new statute a person must be 16 years of age to give their consent to engage in sexual intercourse. Any person who engages in sexual activities with a person under that age limit may face criminal charges. The previous law established in 1892 set that age of consent to 14 years of age.

The law does allow for what is known as a close-in-age provision of five years. That means that it would be legal for a 15 year old to engage in a sexual relationship with a person up to 19 years of age, IF  that older individual was not in a position of exploitation or in a position of trust or authority over the minor.

While most have hailed the new law as something needed and overdue, some gay rights organizations feel that the law is incomplete. It is currently illegal for Canadians under 18 to have anal sex, which means that two consenting 17 year olds would still be in violation of the law.

Most anal fissures are caused by stretching of the anal mucosa beyond its capability. Various causes of this fissure include:

• Straining to defecate, especially if the stool is hard and dry
• Severe and chronic constipation
• Severe and chronic diarrhea
• Crohn’s disease and Ulcerative colitis
• Tight sphincter muscles
• Anal Intercourse

Many acute anal fissures will heal spontaneously. Some fissures become chronic and will not heal. The most common cause for this is spasm of the internal anal sphincter muscle. This spasm causes poor blood flow to the anal mucosa, hence producing an ulcer which does not heal since it is deprived of normal blood supply.

Anal fissures are common in women after childbirth, and following constipation in infants. During childbirth, 11% of women develop anal fissures. Fissures can also be caused by digital insertion (as during an examination), foreign body insertion, or anal intercourse. Most anal fissures are shallow or superficial (less than a quarter of inch or 0.64 cm deep). These fissures self-heal within a couple of weeks.

Pediatric Anal fissures

Anal fissures in infants usually self-heal without anything more than frequently changing diapers and treating constipation if the cause.

What are the symptoms of Anal Fissures?

An anal fissure causes a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last for a few hours.

Fissures may itch. They often bleed lightly or cause a yellowish discharge. You may see a small spot of bright red blood on toilet tissue or a few drops in the toilet bowl. The blood is separate from the stool. Blood mixed with stool indicates some other condition, possibly inflammatory bowel disease (IBD) or colon cancer. You should contact a health professional if you have bleeding with bowel movements or dark, bloody stools.

Occasionally an anal fissure may be a painless wound that won’t heal and that bleeds intermittently but causes no other symptoms.

 Treatments for Anal fissures:

Most acute fissures need some home treatment, including soaking in a shallow tub of warm water (sitz bath) several times a day, increasing fiber in the diet, and taking stool softeners or laxatives. Some people find relief within a day or two of home treatment. Although your pain may go away, it may take several weeks for the fissure to heal completely.

Try to prevent constipation, which can keep a fissure from healing. The pain of a fissure may make you anxious about having bowel movements. However, trying not to have bowel movements will only increase constipation and create a cycle that keeps the fissure open and painful.

Drinking lots of water or other fluids also will make stools soft and easy to pass.