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Thursday, February 5, 2009

Anal Fissure and it’s Treatment

Fissure is a condition characterized by a longitudinal crack or slit (ulcer) in the skin of anus. If the skin lining of the lower end of the anus gets scratched, it may break up into a fissure.

The posterior midline of the anus is the most common location for fissure due to low supply of blood in this area. Rarely, it can be present on the other areas, such as sides of the anus rather than posterior midline position. Such fissure may be the manifestation of underlying disease e.g. Crohn's disease, ulcerative colitis etc.


Natural Remedies of Fissure

  • Diet - As constipation is the main cause of fissure. Take high-fiber diet and extra fluids to prevent constipation. This means diet should include more fruits, vegetables, cereals, etc. and drink at least 8 glasses of water a day. Reducing intake of coffee and alcohol will also improve condition.
  • To relieve pain Apply a warm towel to the area. Warm baths or Sitz baths also relieve pain. Use 8 inches of warm water in the bathtub, 2 or 3 times a day for 5-10 minutes. Use only luke-warm water on this area.
  • Physical activity - No restrictions are necessary. In fact, physical activity reduces the likelihood of constipation.
  • To prevent infection, gently clean the anal area with soap and water after each bowel movement. Do not put any creams or ointments, cornstarch, talcum or other powder, which hazel, or anything else on or into the anus.
  • Develop regular bowel habit.
  • Do not suppress desire of passing stools as this result in hard and large stools, which usually produces injury to the anus.
  • Avoid straining at stools.
  • Avoid anal intercourse.
  • Use stool softeners or laxatives to have pain-free bowel movements. 

Nonsurgical treatments of Fissure

  • Medicated creams or suppositories. Your doctor may prescribe a rectal corticosteroid (Anusol, others) or recommend an over-the-counter cream or ointment containing hydrocortisone (Cortaid, Preparation H) to help reduce inflammation and ease discomfort.
  • Other nonsurgical therapies. Some doctors recommend applying nitroglycerine ointment to the anus, which widens blood vessels and increases blood flow to the tear, promoting healing. This therapy also helps reduce pressure in the anal sphincter, which eases the spasm and decreases pain, both of which promote healing. The dose of nitroglycerine is small to avoid dangerous side effects. Wash your hands thoroughly after applying the ointment to reduce the amount on your skin even further.
  • Side effects such as headaches, low blood pressure and dizziness may occur. Your doctor may advise you to remain seated or lying down and to avoid exercise immediately after applying nitroglycerin to minimize these side effects. Men shouldn't use nitroglycerine within 24 hours of taking erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) because of the possibility of significantly lowered blood pressure.
  • Another fairly new treatment involves injecting a small dose of botulinum toxin type A (Botox) into the internal anal sphincter. Botox paralyzes the muscle for up to three months, causing the spasm to relax. A possible side effect is temporary, mild leakage of gas or stool (anal incontinence).
  • Blood pressure medications nifedipine (Adalat) and diltiazem (Cardizem), taken orally or ground into a gel and applied to the tear, also have shown some promise.
  • Vitamin B complex of about 100 mg. each, except for Biotin which can be about 5-10 mg. and B12 which can be about 100 mcg. It can be taken only once or twice a day. The urine will yellow, coming mostly from the vitamin B2 the riboflavin, so therefore you need not worry about that. Possibly a vitamin B5 deficiency is one of the cause, so taking or buying a separate panthotenic acid, of 500-1000 mg per day should also help, it helps the skin to heal.
  • Often comfrey pastse applied to external to fissue should help the healing. But on the other hand, taking plenty of aloe vera, gel, oil and leaves internally is quite helpful, especially the oil. Both comfrey and the aloe vera have allantoin which should speed up healing.
  • Take plenty of vitamin C, in the form of sodium ascorbate if possible, plus some zinc acetate and magnesium citrate also.
  • To help with circulation helpful to healing, take 1/4 teaspoon of baking soda plus 1/4 teaspoon of citric acid to also alkalize the blood and help with the healing. This is to be taken on empty stomach, once in morning and once before sleeping.  
  • Vitamin B complex should solve most of your chronic fissure problems, but taking evening primrose oil, flaxseed oil, fish oil should help with the tiny fissure cracks also, by balancing your omega 3 and omega 6.

Complicated Fissure

The fissure can be considered as complicated in the following situations:

  • Not responding to conservative treatment.
  • Association with anal polyp.
  • Presence of an external skin tag (sentinel pile).
  • Presence of hemorrhoids or a fistula underneath.
  • Thick edges of fissure.
  • Exposure of the muscle fibers at the floor of the fissure.
  • Infection at the base of fissure.

It has been shown that fissure complicated by any of these facts will not heal spontaneously and will not respond to conservative therapy.

Horses do not get chronic fissures because they eat hay, which are rich in silicon. This helps build skin and therefore taking oatmeal daily should also help.

Different Type of Fissures in wikipedia

More on Anal Fissure in Wikipedia

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