Malady Wise

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Anal Fissure Treatment

Maladywise

Rx

Fact sheet

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