Anal Fissure Treatment

Surgery

27 Jul

Written By Maladywise

Rx

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

Legumes

Vegetables

Fruits

Grains