Anal fissures are small lesions affecting the mucosa of the homonymous orifice.
They cause a lot of discomfort and pain; they often bleed, particularly during the act of evacuating hard stools. A typical sign of anal fissures is the presence of live blood in toilet paper.
The presence of fissures in the innermost part of the anus can cause involuntary spasms that reduce the flow of blood, causing it to become chronic.
We specify that the fissures are NOT hemorrhoids and that they require a partially different pharmacological treatment (vasodilator and non-vasoconstrictor).
The material published is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of anal fissures; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient.
What to do
Anal fissures are a widespread but generally resolvable malaise.
The remedies we are going to list become necessary only when the discomfort does not resolve spontaneously within a few days.
- If present, treat the infection.
- Avoid constipation: the tips for preventing / treating constipation are mainly dietary and behavioral in nature.
- Avoid diarrhea: the recommendations for preventing / treating diarrhea are also basically nutritional and behavioral.
- Practice lukewarm baths and apply anesthetic ointments several times a day (including natural remedies): they are used to decrease pain and relax the muscles of the internal anal sphincter.
- Reduce stress and fear of evacuation: the remedies are pharmacological (anxiolytic) and behavioral (mental training, deep relaxation, etc.). In some cases, excessive fear pushes the subject to postpone defecation, aggravating constipation.
- Use of anal dilators: on medical advice, they can promote healing.
- Proctological surgery: it is a necessary remedy only in the most serious cases.
What NOT to do
- Ignore any infection.
- Neglecting constipation and not dedicating the right time to the defecation phase. If you try too hard, it is almost certain that the fissures will arise or worsen.
- Overdoing the laxatives and leading to diarrhea.
- Neglecting chronic diarrhea (for example, in the case of irritable bowel).
- Prejudice personal hygiene and / or use very aggressive detergents that irritate the mucous membrane of the anus.
- Postponing bowel movements for fear of pain the following episode will certainly become more acute.
What to eat
For further information: Diet for anal fissures
As anticipated, anal fissures have an etiology strictly correlated with diet.
However, dietary therapy can vary from case to case. If anal fissures are caused by constipation or diarrhea, nutritional corrections may turn out to be different.
- To regularize the intestine it is always useful:
- Take supplements based on probiotics and / or fermented foods: among the most suitable foods we recognize the functional ones (for example drinks with added ingredients) and all the others naturally rich in physiological bacteria (yogurt, buttermilk, tofu, tempeh, kefir, etc.).
- Take soluble fiber supplements: inulin, glucomannans, etc. It is important that they are supplements without insoluble fiber and osmotic laxatives.
- In case of constipation:
- Increase the amount of dietary fiber up to and beyond 30g / day; they are mainly contained in: vegetables, fruits, whole grains and legumes.
- Drink water for at least 1ml / kcal of energy in the diet: in the average person, about 1.8-2.0 liters per day.
- Ensure a percentage of 25-30% of fat in the diet: they have a lubricating effect. Vegetable oils rich in anti-inflammatory molecules such as omega 3, vitamin E and polyphenols (linseed, kiwi, grape seed, walnut oil) are preferred; also the extra virgin olive oil.
- In case of diarrhea:
- It may be useful to follow a low residue diet, especially as regards the percentage of insoluble fiber. On the contrary, the soluble ones have a gelling function that sometimes helps to improve the consistency. For further information: Diet for Diarrhea
What NOT to Eat
- In case of celiac disease, avoid gluten (contained in wheat, spelled, spelled, rye, oats and sorghum).
- In case of lactose intolerance, avoid milk and derivatives.
- Avoid alcohol: they tend to irritate the intestines and dehydrate the body. In the first case they worsen diarrhea and in the second constipation.
- As a percentage of total fibers, reduce the amount of insoluble fibers: contained above all in the bran, in the peel of legumes, etc .; they could have negative effects in case of diarrhea.
- Avoid irritating molecules (pepper, chilli, etc.) and nerves (coffee, cocoa, etc.).
- In case of diarrhea, avoid laxative foods: kiwi, beer, honey, broth, hot milk, peaches, licorice, tamarind, cassia etc.
- In case of constipation, avoid astringent foods: banana, lemon, medlar, tea, blueberries etc.
Natural Cures and Remedies
- Laxatives with a laxative and emollient effect for oral use. They make the stool soft, flowing, reducing dilation and irritation / bleeding: Linseed, Psyllium and Inulin.
- Mallow, Plantain and Altea, also for oral use, as well as as laxatives they also work as anti-inflammatory and healing agents.
- Comfrey, Aloe Vera Gel, Yarrow Yarrow and essential oils (lavender, cypress, sage, St. John's wort, thyme, centella asiatica and geranium): used as a decoction or in cream or in lukewarm solutions (both for external use), they have anti-inflammatory, healing effects , antimicrobials, immunostimulants and anesthetics.
Pharmacological treatment
For further information: Medicines for the treatment of anal fissures
Pharmacological remedies for the treatment of anal fissures are:
- Lidocaine: for example: Xylocaina, Lidofast, Luan CHIR. It is a topical anesthetic product, used in pain therapy for both anal fissures and hemorrhoids. Sometimes it is associated with steroids (hydrocortisone) with an anti-inflammatory function. These drugs are very useful when pain interferes with intestinal peristalsis.
- Psyllium seeds: for example Fibrolax. It is a laxative that increases fecal volume, to be used in case of anal fissures caused by constipation. It is to be introduced orally in doses of 3.5g after meals, about 2 or 3 times a day for 2-3 days; it requires drinking plenty of water.
- Nifedipine and Lidocaine: for example Antrolin. It is a cream for local use based on calcium antagonists. It is applied in the rectum to relax the peripheral smooth muscle and is associated with Lidocaine. It should be applied 2 times a day for at least 6 weeks.
- Diltiazem: for example Cardizem. It works like the previous one and is used in association with cortisone.
- Nitroglycerin. Ointment (0.2-0.3-0.4%) for topical use. To be applied 2-3 times a day (even for 6 months) after a thorough cleaning.
- Trinitroglycerin: for example Rectogesic. It is a muscle relaxant indicated to reduce pain even in the most severe cases. Application is recommended every 12 hours for no more than three weeks.
- Botulinum Toxin: such as Botox, Vistabex, Bocouture and Xeomin. By injecting these poisonous compounds a chemical denervation of a few months is obtained; this is useful in relaxing the muscles.
Prevention
The prevention of anal fissures is quite simple, even if subjectivity plays a fundamental role in the onset:
- Prevention of constipation:
- Diet rich in fiber and water.
- Regular life, not sedentary or hectic, with the right time to devote to evacuation.
- Prevention of diarrhea:
- Avoid foods responsible for adverse reactions (gluten for celiacs and lactose for intolerant).
- Avoid intestinal infections.
- Avoid the alteration of the intestinal bacterial flora.
- Avoid overindulging with laxatives.
- Take care of personal hygiene but do not overdo the aggressiveness of the detergents.
Medical treatments
- Partial resection of the internal anal sphincter: simple operation with a hospitalization of about one day; the complications are statistically insignificant.
- Annuloplasty: it is also considered an easy surgery and discharge takes place in about 24 hours; complications are rare. It is based on covering the injured area by bringing back flaps of skin taken from high positions of the body.
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