Anal Fissure Treatment

---

Rx

Fact sheet

• Anal Fissure Treatment Fact Sheet [PDF]

Treatment

Initial medical therapy is 4 to 8 weeks of

• Increased fibre

  • Recommended intake 20g to 35g per day through diet

    • See blow for quantities

• Warm water Sitz bath 2 to 3 times daily

  • Sitting in warm water for 10 to 15 minutes

  • This stimulates blood flow to the perineum allowing it to heal

• Stool softeners if constipated

  • Coloxyl + Senna

• Twice daily topical vasodilator cream

  • Glyceryl Trinitrate 0.4% (Rectogesic)

  • Nifedipine 0.2 to 0.3%

    • Nifedipine needs to be compounded but has less side effects and can be used up to 4 times daily.

    • One study showed healing rates for Nifedpine versus GTN were 89% versus 58% and fewer side effects at 5% versus 40%.

• Topical anaesthetic agents

  • Don’t improve outcomes but can help pain short-term

  • Proctosedyl (Corticosteroid + Local Anaesthetic)

  • It’s possible to get a compounding pharmacist to make a local anaesthetic and vasodilator combination

If medical therapy fails then the next steps are either Botox injection or a lateral sphincterotomy

Rates of success for surgery versus medical management were 96 vs 67% at 5 weeks and 100 versus 89% at 10 weeks

• Both were combined with Sitz baths and fibre-bulking agents.

• The downside to surgery was increased rates of faecal incontinence with over 15% of patients still having problems at 2 years post-surgery

Fibre sources

Legumes

• Split peas boiled (1 cup) = 16g

• Lentils, boiled (1 cup) = 15.5g

• Black beans boiled (1 cup) = 15g

• Baked beans, canned (1 cup) = 10g

• Chia seeds x 30g weight = 10g

• Almonds x 23 nuts = 3.5g

• Pistachios x 49 nuts = 3g

Vegetables

• Green peas (boiled x 1 cup) = 9g

• Broccoli (boiled x 1 cup) = 5g

• Brussels sprouts (boiled x 1 cup) = 4g

• Potato with skin x baked (1 medium) = 4g

• Sweet corn (1 cup) = 3.5g

• Cauliflower raw (1 cup) = 2g,

• Carrot raw (1 medium) = 1.5g

Fruits

• Raspberries (1 cup) = 8g

• Pear (1 medium) = 5.5g

• Apple with skin (1 medium) = 4.5g

• Banana (1 medium) = 3g

• Orange (1 medium) = 3g

• Strawberries (1 cup) = 3g

Grains

• Spaghetti, whole-wheat, cooked (1 cup) = 6g

• Bran flakes (1 cup) = 7g

• Quinoa cooked (1 cup) = 5g

• Oat bran muffin (1 medium) = 5g

• Oatmeal cooked (1 cup) = 5g

• Popcorn, air-popped (3 cups) = 3.5g

• Brown rice cooked (1 cup) = 3.5g

• Bread, whole-wheat (1 slice) = 2g