Anal fissure diet

Purpose of the Diet

The anal fissure diet is a nutritional system aimed at the prevention, reduction of symptoms and remission of anal fissures.
We remind you that, however specific and correct, the diet is not always completely decisive; in fact, for certain levels of severity, the joint application of medical therapy becomes fundamental.

Figure: Psyllium seed powder, particularly suitable for softening the stool in case of fissures associated with constipation

NB. Cracks are NOT hemorrhoids; although they affect (more or less) the same intestinal tract and, despite having various causes in common, they must be treated pharmacologically in a different way. To learn more, see the articles: drugs for the treatment of anal fissures and drugs for the treatment of hemorrhoids.

Anal fissures

Anal fissures are elementary skin lesions of the anal canal, often superimposed on infectious, inflammatory (dermatitis) or, more rarely, psoriasis pictures.

In the etiology of anal fissures, in addition to the physical stress associated with the passage of hard or irritating stools, inflammation of the anal mucosa plays a more than determining role.
The fissures can show a bright red color and immediately reveal themselves with traces of fresh blood (bright red) in the toilet paper.

In acute form they cause severe pain in the anus, both during and after defecation, while chronic fissures cause much less discomfort.
Anal fissures generally occur near the anal opening, especially posterior to the midline; this is likely to be due to poor blood perfusion and the specific shape of this area.
The depth of the anal fissures is variable, from superficial to deep, reaching the underlying sphincter muscle. Upon visual examination, the superficial fissures may show themselves as cuts so thin that they are difficult to identify; generally, they heal spontaneously in about two weeks. However, some become chronic and reach the deeper layers.
The most frequent cause of chronicity are spasms of the internal anal sphincter muscle, which makes defecation even more difficult and alters the blood supply to the anal mucosa, favoring bacterial proliferation.

Causes

Most anal fissures are due to excessive stretching of the anal mucosa. In adults, this occurs mainly due to constipation and the associated passage of excessively large and hard stools; however, paradoxically, the fissures can also occur in the case of prolonged diarrhea, due to the irritating effect of unformed stools.

In the elderly, the reduction of blood flow also plays a fundamental role.
When anal fissures are located to the side and deeper, they can be related to other pathological pictures, such as carcinoma or chronic inflammatory bowel diseases (ulcerative rectal colitis, Crohn's disease); in this case, diagnostic tests are required for the differentiation from more serious disorders.
As with proctitis, anal fissures can also be favored by certain sexually transmitted infections, which favor the rupture of the tissue with consequent cracking. Some examples are: syphilis, genital herpes, chlamydia and papilloma virus.
Secondary causes of anal fissures are: birth trauma in women, anal sexual activity and poor hygiene (especially in children).

Prevention and Treatment

The prevention and treatment of anal fissures are based on:

Suitable diet
Delicacy in defecation
Hygiene of the anus
Treatment of diarrhea
Frequent diaper changes in babies.

In general, in less severe cases, the diet is sufficient to ensure that the anal fissures heal completely. In the next chapter we will analyze it more accurately.
In the event that the dietary therapy fails or manages to soften the stool only partially, it becomes essential to decrease the intra-abdominal pressure and the consequent excessive (or too abrupt) distension of the anus.

A very useful precaution is to allow the right time for defecatory activity.
Furthermore, the use of lubricating ointments can be very useful, as long as they are not aimed at the treatment of hemorrhoids. In fact, the latter are based on vasoconstrictors and would exert an action diametrically opposite to that necessary for the healing of anal fissures.
In the most severe cases it may be necessary to use anesthetic drugs, topical nitroglycerin or calcium channel blockers; alternatively, a localized injection of botulinum toxin is proposed (for relaxation of the anal sphincter).

Diet

As for the diet against anal fissures, the main objective is to reduce the consistency of the stool. This result can be achieved by:

the "increase in the amount of fiber (especially soluble)
the increase in the share of water
l "increase in the share of vegetable oils (if deficient).

Even without any other precautions, these three nutritional interventions are generally able to favor the evacuation, reducing the necessary efforts and increasing the speed, as well as the frequency of the sessions.
The increase in the amount of fiber can also be obtained by means of supplements based on soluble molecules such as inulin and glucomannans; on the contrary, it is better to avoid osmotic and irritating laxatives such as lactulose and anthraquinones.
In addition to modifying the fecal consistency, it is possible to obtain a "further reduction of painful symptoms by eliminating irritants from the diet. Among these, the molecules responsible for the spicy taste stand out, in particular:

Chilli capsaicin
Black pepper piperine
Ginger gingerol
Isothiocyanate from horseradish, mustard seeds and wasabi
Allicin of garlic, onion, shallot, etc.

The same goes for some nerves, such as:

Ethyl alcohol of all alcoholic beverages
Caffeine from coffee
Theobromine of cocoa
Theine of fermented teas.

ANAL fissures and diarrhea

As anticipated, anal fissures can also appear in the case of prolonged diarrhea. This is attributable to the presence of:

Contraindicated molecules such as, for example, lactose and gluten for the intolerant
Irritant molecules (see above).

For more information, see the article dedicated to the Diarrhea Diet

It should also be remembered that the nutritional excess of fats causes a reduction in fecal pH and that, on the contrary, that of proteins increases it; both contribute to negatively select the intestinal bacterial flora, preferring the putrefactive one and playing an unfavorable role for the healing of fissures.

It is therefore logical to think that even for fissures, as well as for other intestinal pathologies, taking probiotics can prove to be a positive attitude.

ANAL fissures in infants

Unlike adults, in whom dehydration is only one of the various predisposing factors, dehydration is an element of primary importance in newborns. Parents must therefore make sure that the amount of breast milk is sufficient and that, if artificial formulas are used, that the dilution ratio is correct.

The resolution of fissures in children is much faster than in adults.