ANAL FISSURES - DRUGS FOR THE TREATMENT OF ANAL FISSURES

Definition

Anal fissures are small but deep cuts in the skin surrounding the anus; these annoying micro-cracks can generate pain associated with bleeding, which becomes more intense during evacuation or following an effort. Hard and particularly bulky stools can accentuate the problem, damaging the anal folds.

Causes

Anal fissures are extremely common in the elderly and newborns, although they can occur at any age; the alteration of intestinal motility, whether this constipation or diarrhea, constitutes the etiological factor that most predisposes to the formation of anal fissures. In the elderly, this condition can be favored by the physiological decrease in the blood supply in the affected area; Anal fissures are quite common in women who have just given birth and in patients with Crohn's disease.

Medicines

Fortunately, most of the time anal fissures are a pathological condition that can be solved easily and in a short time; in some patients, even the fissures in the perianal area are resolved without the need for pharmacological treatments or special treatments.
Clearly, anal fissures are not always so simple to cure; therefore, if the disorder persists, it is recommended to undertake a simple drug treatment, in addition to correcting eating habits. The regularization of the diet seems to be a fundamental point to speed up the patient's recovery: a "diet rich in fiber and abundant in water is certainly a valid aid to facilitate defecation, regulating intestinal motility.
It is recommended to soak in warm water several times a day: the heat of the water relieves the painful anal area affected by fissures.

The following are the classes of drugs most used in the therapy against anal fissures, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:

Lidocaine (eg. Xylocaine, Lidofast, Luan CHIR): it is a local anesthetic, widely used in therapy to reduce pain associated with anal fissures and hemorrhoids. It is often formulated together with steroids such as hydrocostisone (eg Proctosedyl), useful for enhancing the anti-inflammatory effect. These drugs are particularly effective when pain interferes with the physiological bowel movement.

Psyllium seeds (eg Fibrolax): the product is a volume laxative, recommended in case of anal fissures associated with constipation. It is recommended to take the drug orally, at a dosage of 3.5 grams after meals, 2-3 times a day, for 2-3 days. Take the product with plenty of water, in order to increase the fecal content. Do not continue therapy beyond what is due.

Nifedipine and lidocaine (eg Antrolin): the rectal cream based on nifedipine (drug class: calcium antagonists, useful for promoting a "relaxing action of peripheral smooth muscles) and lidocaine (local anesthetic) is indicated for the treatment of anal fissures : it is recommended to apply the drug twice a day for at least 6 weeks.

Diltiazem (eg Cardizem) this active ingredient, like the previous one, belongs to the class of calcium channel blockers and is used in therapy for the treatment of anal fissures in association with local or costisonic anesthetics for topical application. Consult your doctor.

Nitroglycerin (ointment with a concentration of 0.2-0.3-0.4%): apply a thin layer of cream on the skin affected by the anal fissure, 2-3 times a day after a thorough cleansing of the area. The therapy can be also continued for 6 months.

Trinitroglycerin (eg. Rectogesic): the drug (muscle relaxant) is indicated to solve the pain associated with anal fissures of medium or severe entity. Apply 1 cm of ointment (corresponding to approximately 375 mg of product, which contains 1.5 mg of active ingredient) in the perianal area every 12 hours; continue the therapy for no more than three weeks.

Botulinum toxin (eg Botox, Vistabex, Bocouture, Xeomin): by injecting a small dose of botulinum toxin directly into the anal sphincter, a chemical denervation lasting a few months will be created, useful for relaxing the muscles. Botulinum toxin is injected into the internal and external sphincters; this treatment promotes healing from anal fissures.

If no attempt described above would benefit the patient suffering from anal fissures, the only possible option is represented by surgery (anoplasty, balloon-controlled dilation or lateral sphincterotomy); it is the doctor's duty to choose the most suitable therapeutic option to ensure the definitive recovery of the patient from anal fissures.