Materiały źródłowe

• #1 Anal fissure: Clinical manifestations, diagnosis, prevention – UpToDate

  https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention

  Anal fissure is one of the most common benign anorectal diseases and one of the most common causes of anal pain and anal bleeding. […] The pathogenesis, clinical manifestations, diagnosis, and prevention of primary sporadic anal fissure are discussed in this topic, while the medical and surgical treatment is presented in other topics. […] Anal fissures most often affect infants and middle-age individuals. […] The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure in as many as 40 percent of patients. […] The exposed internal sphincter muscle within the bed of the fissure frequently spasms, which not only contributes to severe pain but also can restrict blood flow to the fissure, preventing its healing.

• #1 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent one from coming back. Changes include: […] Adding fiber to your diet. Eating about 25 to 35 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. […] Drinking adequate fluids. Fluids help prevent constipation. […] Not straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. […] Sitting in a warm bath. Also called a sitz bath, soaking in a warm-water bath for 10 to 20 minutes several times a day can soothe the skin and promote relaxation. If possible, take a sitz bath after bowel movements.

• #1 Anal Fissure: Signs, Causes, Treatment & Prevention | Medcare

  https://www.medcare.ae/en/health-library/anal-fissure-symptoms-causes-and-treatment.html

  Anal fissures can be prevented by implementing several lifestyle changes including: […] Increasing the fiber content in your diet. Fruits, vegetables, nuts, whole grains contain a lot of fiber adding them to your diet can greatly reduce the risk of constipation. The recommended daily fiber intake to keep stool from hardening is approximately 25 to 30 grams. Fiber supplements can sometimes also fulfill this requirement. […] Increasing liquid intake can prevent constipation by helping stool move easily through the digestive tract. […] Do not strain yourself during bowel movements. Straining or forcing bowel movements can create pressure in the anal canal causing tears in the skin. […] Exercising regularly promotes digestion healthy bowel movements. […] Anal fissures in infants can be prevented by changing diapers frequently. […] If you are suffering from diarrhea, take immediate proactive steps to treat it. […] Keep the anal area dry.

• #1 How to cure fissures permanently without surgery

  https://www.medicalnewstoday.com/articles/how-to-cure-fissures-permanently-without-surgery

  Frequent fluid intake prevents dehydration, while not drinking enough can lead to harder stools that are more difficult to pass. […] A 2015 study shows that a high fiber diet effectively treated 87% of acute anal fissures in 3 weeks, and continuing the diet for 1 year, prevented their recurrence. […] Sitz baths involve soaking in warm water in a tub for 10-20 minutes. Baths relax the sphincter muscles and help soothe the pain from fissures. […] Straining to pass hard stools often causes cracks or tears in the anus. […] Laxatives can help people pass stool more easily. […] Applying topical anesthetics, such as lidocaine, to the skin around the anus can help provide pain relief. […] Topical nitrates, for example, nitroglycerine, will help relax the muscles around the anus and increase blood flow to the fissure to promote healing.

• #1 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  You cannot prevent anal fissure in every case. Because sometimes doctors do not find a cause for it or anal fissure is the result of another disease. However, there are some factors that increase the risk of anal fissure and you can address these yourself. Examples are: […] Prevent constipation: Eat as balanced a diet as possible and consume plenty of fiber (e.g., whole grains, fruits, vegetables, legumes). Also, drink plenty of fluids. Recommended is at least 1.5 to 2 liters per day. Low-calorie drinks such as water, unsweetened tea or fruit juice spritzers are best. A soft stool lowers the risk of anal fissure. Even after anal fissure treatment, these tips are important to prevent a new fissure. Laxatives are then usually unnecessary otherwise talk to your doctor before taking them. […] Move a lot in everyday life and do sports. Exercise stimulates bowel activity. For example, take a walk after dinner, climb stairs instead of taking the elevator, or ride your bike to the supermarket instead of getting in your car. If you have a sedentary job, for example, in an office, it is best to try to move as much as possible even during working hours. Take the folder to your colleague yourself instead of putting it in the in-house mail, or stand up when you make phone calls. Exercise not only protects you from anal fissure, but also strengthens your overall well-being.

• #1 Fissure Prevention and Health: How to Avoid Recurrence – NA Hemorrhoids

  https://nahemorrhoidscentre.ca/duplicated-what-to-do-about-anal-fissures-vancouver-patients-most-common-questions-6109/

  Fissures are a common anal disorder that brings a lot of discomfort and pain to patients. […] Fortunately, by making some simple dietary and lifestyle adjustments, we can effectively prevent the recurrence of fissures. […] Diet is a cornerstone in the prevention of anal fissures, a condition that arises primarily due to the passage of hard stools and the resulting strain during bowel movements. […] Adequate hydration ensures that the stool remains soft and moist, facilitating smoother transit through the intestines and easier evacuation. This reduces the strain on the anal region during defecation, which is crucial in both the prevention and the healing of fissures. […] By maintaining these dietary practices, individuals can significantly reduce the risk of constipation, thus preventing the strain that leads to the development and recurrence of anal fissures.

• #1 Anal fissure | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anal-fissure

  Many cases of anal fissures are caused by chronic constipation. Suggestions include: […] Eat a high-fibre diet. […] Drink plenty of water to help soften stools. […] Consider using a fibre supplement (such as Metamucil). […] Make sure to wipe gently after going to the toilet.

• #1 Anal Fissure Disease: Prevention and Quality of Life | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-49244-5_7

  Anal fissures have a tendency for recurrence or chronicity. Katsinelos et al. (2006) observed 16% recurrences, and Jensen et al. (1987) 25%. Therefore, strategies to avoid such developments should be designed. […] In a double-blind, placebo-controlled study concerning 90 patients with acute anal fissure, Jensen (1987) was able to prove that after the administration of 5 g of unprocessed bran (three times daily over a year), a recurrence affected only 16% of the cases. The placebo group, however, showed 68% recurrences. Bran absorbs four times its weight in water, and thus effects a voluminous stool which leads to a physiological dilatation of the anus during its passage. […] Contrary to bran, Plantago ovata (flee seed husks; Mucofalk) increases substantially in volume, so that its administration promises an even better therapeutic effect.

• #1 Anal Fissure – Athens Hernia Clinic

  https://www.athensherniaclinic.com/anal-fissure/

  Prevention of constipation The single most important aspect of treatment for an anal fissure is the prevention of constipation. You need to take a fiber supplement such as Benefiber, Metamucil, Citrucel, or Konsyl. We recommend: 1. One tablespoon of any of these in 8 ounces of water or juice twice daily. 2. Please drink 8 glasses of water daily. 3. Eat a diet high in fiber including fruits and vegetables (30 grams/day) […] The best way to prevent recurrence is to take a daily fiber supplement and drink plenty of water.

• #1 Anal Fissure | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/patient-care/cope-center/anorectal-disorders/anal-fissure/

  Maintain a high fiber diet (25-30 grams) You will be provided with a fiber information sheet. If you take a fiber supplement, it should be taken in the morning or afternoon (not before bed). Drink fiber supplements with plenty of fluids to reduce the chances of constipation. […] Sitz baths This is a method to provide pain relief and speed the healing of the fissure. This involves sitting in a warm bath or shower, directed at the anal area. These should be done two to three times a day for 10 to 15 minutes. These can also be used to clean the anal area after a bowel movement to avoid further irritation caused from using toilet paper. […] Bowel habits Avoid straining to have a bowel movement. The high-fiber diet should help soften the stool to make it easier to pass, reducing the need to strain. If increasing fiber does not soften the stool, try over-the-counter stool softeners (such as docusate sodium Colace) and/or laxatives (milk of magnesia, mineral oil, magnesium citrate, or Miralax preferred). Diarrhea can worsen the fissure.

• #1 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  You can prevent an anal fissure, which is a tear in the tissue lining your anus, by taking steps not to get constipated. […] To help these fissures heal and keep them from coming back: Eat a healthy diet that has plenty of fiber. Stay well-hydrated. Avoid being constipated. […] Once you have an anal fissure, you’ll definitely want to avoid getting another one, so follow these simple steps. […] Get plenty of fiber. If you’re constipated, passing large, hard, or dry stools can cause an anal fissure. Getting plenty of fiber in your diet especially from fruits and vegetables can help prevent constipation, though. […] Stay hydrated. That can help you prevent constipation. Drinking plenty of liquids adds fluid to your system, which can make stools softer and easier to pass. […] Exercise. One of the most common causes of constipation is a lack of physical activity. Exercise for at least 30 minutes most days to help keep your digestive system moving and in good shape.

• #1 Anal Fissure: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.anal-fissure-care-instructions.uh3165

  Anal fissures can be prevented by avoiding constipation. […] Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber. […] Drink plenty of fluids. […] Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week. […] Take a fiber supplement, such as Benefiber or Metamucil, every day if needed. […] Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. […] Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. […] Your doctor may recommend an over-the-counter laxative, such as Miralax, Milk of Magnesia, or Ex-Lax. […] Use baby wipes or medicated pads, such as Preparation H or Tucks, instead of toilet paper to clean after a bowel movement. These products do not irritate the anus.

• #1 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  Don’t ignore your urge to go. If your body tells you it’s time to have a bowel movement, don’t put it off till later. […] Practice healthy bathroom habits. These tips can help lessen constipation and strain on the anal canal. […] Ask your doctor about laxatives. If adding fiber to your diet and taking fiber supplements aren’t enough to treat constipation, laxatives may help. […] Avoid things that will irritate your skin. This includes scented soaps or certain kinds of bubble baths.

• #1 15 Steps to Prevent Anal Fissures Effectively

  https://www.nirvahealth.com/blog/steps-to-prevent-anal-fissures

  Fissure-in-ano or anal fissure is a health condition in the anal canal where there is a tear in the anal mucosa. This painful condition seen at the end part of your gut or intestines is caused by how healthy your gut is. Even though there are enough treatments for anal fissure, the best way to combat this recurring condition is prevention. […] Understanding your gut and how it works is the best way to prevent the occurrence of anal fissures. […] A diet rich in fibre promotes soft and smooth bowel movements. This prevents constipation and improves gut health. […] Intake of enough water helps keep the stools smooth and hydrated. Non-hydrated bowels make the stools hard and sharp, injuring the anal canal as they pass. […] Pushing or straining during bowel movements will injure your anal lining. Regularising your bowel timings is the best way to ensure you pass your stools without difficulty by letting them go off at their own pace and time.

• #1 Anal Fissures: Self-Care and Prevention

  https://www.health.com/anal-fissure-self-care-8679729

  Incorporating healthy habits into your daily routine that ensure regular, strain-free bowel movements can help prevent anal fissures. These include the following: […] Don’t strain during bowel movements. If you have difficulty passing stool, stay on the toilet for no longer than 10 minutes and try again later. Consider using a foot or squat stool to help achieve a more natural position for easier elimination. […] Eat plenty of fruits, vegetables, legumes, and whole grains to ensure a fiber-rich diet and help prevent constipation and hard stools. […] Moderate physical activity at least 3-4 times weekly helps prevent constipation. […] If you feel the urge to have a bowel movement, don’t delay or hold it in. […] Keep your anal area clean and dry. After bowel movements, gently clean the area with water (e.g., bidet), toilet paper, or wipes and pat dry. Avoid using hard soaps or wipes containing chemicals that can irritate the skin.

• #1 Understanding anal fissures: Causes, symptoms, diagnosis and treatment options | King Edward VII’s Hospital

  https://www.kingedwardvii.co.uk/health-hub/anal-fissures-causes-symptoms-diagnosis-treatment-options

  Drinking enough water can help prevent constipation and make stools easier to pass. […] Regular exercise can help keep your digestive system functioning properly and prevent constipation. […] After bowel movements, clean the area around the anus gently with warm water and a soft cloth or toilet paper. Avoid using harsh soaps or wipes that can irritate the skin. […] Straining during bowel movements can cause trauma to the anal area and increase the risk of developing anal fissures. If you are constipated, try using a stool softener or fibre supplement to make bowel movements easier. […] Sitting for prolonged periods of time can put pressure on the anus and increase the risk of developing anal fissures. Make sure to take breaks and move around periodically throughout the day. […] Certain medical conditions, such as Crohn’s disease, ulcerative colitis and inflammatory bowel disease, can increase the risk of developing anal fissures. Seek treatment for any underlying conditions that may be contributing to your symptoms.

• #1 Anal Fissure | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/patient-care/cope-center/anorectal-disorders/anal-fissure/

  Pain medications Over-the-counter anti-inflammatory agents (example: Ibuprofen, Advil, Aleve, and Motrin) are the preferred medications to decrease inflammation and help with pain. Narcotic pain medications should be avoided because of the constipation they may cause, worsening the fissure. […] Cleansing Try to avoid toilet paper as this will further irritate the area. Instead use sitz-baths/showers or gentle cleansing with a moist wipe for sensitive skin. Avoid wipes with fragrance as they typically have alcohol and can irritate you skin. […] Lidocaine 2% jelly Lidocaine is a topical anesthetic that will numb the anal fissure, reducing symptoms. Lidocaine can be applied two to three times a day as needed. […] Nifedipine 0.2% ointment Nifedipine may be prescribed for chronic fissures to decrease anal sphincter spasm; it improves blood flow to the area, healing the fissure. It is applied twice daily and takes at least 4 to 6 weeks to be effective.

• #1 Anal fissure: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001130.htm

  To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently. […] Prevent hard stools and constipation by: […] Making dietary changes — eating more fiber or bulk, such as fruits, vegetables, and grains […] Drinking more fluids […] Using stool softeners. […] A sitz bath is a warm water bath used for healing or cleansing. Sit in the bath 2 to 3 times a day for 10 to 15 minutes each time. The water should cover only the hips and buttocks.

• #1 15 Steps to Prevent Anal Fissures Effectively

  https://www.nirvahealth.com/blog/steps-to-prevent-anal-fissures

  If you wear tight clothes around your waist and buttocks, it can contribute to anal discomfort and risk of anal fissures. […] A warm water sitz bath helps your anal muscles to relax and gives an improved blood flow. This helps in healing whatever cuts you have. […] You must follow good hygiene, dietetic rules, and anything that keeps your gut healthy. Regularising bowel movements is the first step to take to prevent recurrence of anal fissures. […] Yes, anal fissures are preventable. All you have to do is be mindful of your food and bowel habits. Apart from this, good toilet hygiene, clothing and gut health add to your prevention goals.

• #1 Anal Fissure – Milton Keynes University Hospital

  https://www.mkuh.nhs.uk/patient-information-leaflet/anal-fissure

  Anal fissures are common in both adults and children. […] If you keep the stools soft, and avoid getting constipated, it will help a fissure to heal and help to prevent it happening again. […] The best way to avoid a further fissure is not to become constipated by using the measures described above. That is, a high fibre diet, fluid, etc. […] Avoid painkillers that contain codeine such as cocodamol, as they are a common cause of constipation.

• #1 Anal fissure – Wikipedia

  https://en.wikipedia.org/wiki/Anal_fissure

  For adults, the following may help prevent anal fissures: Avoiding straining when defecating. This includes treating and preventing constipation by eating food rich in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents. Similarly, prompt treatment of diarrhea may reduce anal strain. […] In infants, frequent diaper change can prevent anal fissure. As constipation can be a cause, making sure the infant is drinking enough fluids (i.e. breastmilk, proper ratios when mixing formulas) is beneficial. In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs.

• #1 Anal Fissure Signs & Symptoms | Rush

  https://www.rush.edu/conditions/anal-fissure

  Lifestyle changes, such as eating more high-fiber foods and drinking more fluids, to ease your pain and prevent future anal fissures […] When you come to Rush, your care team includes some of the country’s leading experts in anal fissure prevention and treatment. […] You may have an anal fissure that does not require medication, an injection or surgery to improve. If so, our doctors can make sure that you still get the care you need to heal your fissure and prevent future problems, based on your specific needs and preferences. […] If you have anal fissures associated with Crohn’s disease or ulcerative colitis, our expert IBD team can provide the support you need to manage your IBD and help you avoid fissures in the future.

• #1 Anal Fissure

  https://healthlibrary.uwmedicine.org/Library/DiseasesConditions/Adult/Digestive/134,174

  An anal fissure is a tear in the tissue of the anus. […] The most common cause is large or hard stools because of constipation. […] A person is more at risk for an anal fissure if they have any of the below: Constipation that makes you strain to pass hard stool, A low-fiber diet, A lot of diarrhea, Recent weight loss surgery, if it leads to frequent diarrhea, Vaginal childbirth, Minor injury, such as from mountain biking, Any inflammatory condition of the anal area, Inflammatory bowel disease, Infection or HIV, Surgery, Other medical treatments that affect bowel movements or the anus. […] An acute anal fissure is one that lasts for a short time. It often heals within 6 weeks with simple treatment. It may heal when constipation is treated. […] Other treatments include: Changes in your diet. You may need to eat more fiber and drink more water to help ease diarrhea or constipation. It’s very important to treat constipation, or the fissure is likely to come back. […] To help prevent constipation or large or hard bowel movements: Get enough fiber in your diet. Drink enough water to stay well hydrated.

• #1 6 At-Home Anal Fissure Treatments to Try

  https://www.healthline.com/health/anal-fissure-treatment-at-home

  Preventing anal fissures involves maintaining good bowel habits and reducing the risk of trauma to the anal area. […] Here are some preventive measures to consider: […] Consume a high fiber diet to keep stools soft and regular. Include fruits, vegetables, whole grains, and plenty of fluids in your diet. […] Drink an adequate amount of water to stay well hydrated. […] Go to the toilet when you have the urge to have a bowel movement. Avoid delaying it. […] If you’re having trouble passing stools, consider using stool softeners or fiber supplements under medical guidance. […] Use soft, unscented toilet paper. Consider using wet wipes or a bidet for a gentler cleaning. […] Regular physical activity can help promote healthy bowel function. […] Avoid using harsh soaps or excessive scrubbing. After a bowel movement, gently cleanse the area with warm water or a mild, unscented soap and pat dry. […] Consider using a water-based lubricant before anal intercourse to reduce friction and the risk of injury.

• #1 Anal Fissures Management and Treatment

  https://www.drsamratjankar.com/blogs/anal-fissures-management-and-treatment/

  Prevention of Anal Fissures […] – Fissures in infants: […] – Changing diapers frequently […] – Treat constipation immediately […] – Fissures in adults: […] – Keep your anorectal area dry […] – Wipe the area using soft materials, a cotton pad, or a moistened cloth. Do not use rough and scented toilet paper. […] – Promptly treat all constipation and diarrhea problems […] – Do not irritate the rectum […] – If you find yourself suffering from constant constipation or any other symptoms we mentioned, consult your doctor. The sooner you treat your problem, the better it is for you. […] – Use over-the-counter stool softeners to treat an anal fissure at home. […] – To stay hydrated and enhance digestion, drink more water. […] – Taking fiber supplements and eating more fibrous foods are two ways to improve your fiber intake. […] – To relax the anal muscles, reduce discomfort, and enhance blood flow to the anorectal area, take a sitz bath.

• #1 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  A high-fiber diet can help keep your stools regular and easily passable. This is a key factor in preventing future anal fissures. […] Eating a high-fiber diet, drinking plenty of fluids, taking sitz baths, and using anti-inflammatory ointments can help current fissures heal and prevent new ones. […] You cant always prevent anal fissures, but you can reduce your risk of getting one by taking the following preventive measures: keeping the anal area dry, cleansing the anal area gently with mild soap and warm water, drinking plenty of fluids, eating fibrous foods, and exercising regularly to avoid constipation, treating diarrhea immediately, changing infants diapers frequently if they have the condition.

• #1 Anal Fissure Treatment Guidelines – Paul E. Savoca

  https://www.paulsavocamd.com/conditions/anal-fissure-treatment-guidelines/

  5. Lateral internal sphincterotomy is the surgical treatment of choice for refractory anal fissures. Grade of Recommendation: Strong recommendation based on high-quality evidence 1A […] Multiple studies and a recent Cochrane review show that LIS is superior to uncontrolled manual anal dilation, yielding superior healing rates with less incontinence. […] 6. Surgery is consistently superior to medical therapy and may be offered without a pharmacological treatment failure. Grade of Recommendation: Strong recommendation based on high-quality evidence 1A […] Multiple trials continue to confirm the superiority of LIS to any topical or injected agent with low rates of incontinence. Quality of life (QOL) is poor in patients with persistent fissure, whereas patients undergoing LIS report significantly improved QOL.

• #2 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics

  ANAL FISSURE TREATMENT […] Fiber therapy — Avoiding hard bowel movements will prevent trauma to the anal canal, promoting healing of the fissure. Increasing fiber in the diet is one of the best ways to soften and bulk the stool. Fiber is found in fruits and vegetables. The recommended amount of dietary fiber is 20 to 35 g/day. […] […] […] Laxatives — A variety of drugs and natural products are available for treating constipation. People are often concerned about the regular use of laxatives, fearing that they will not be able to have a bowel movement when the laxative is stopped. However, with the exception of cathartic laxatives (such as senna-related products), there is little to no evidence that laxatives increase the risk of constipation in the future. […] […] […] Topical nifedipine and topical nitroglycerin — Topical nifedipine works by reducing the internal anal sphincter pressure. Nifedipine is available in pill form for other indications (eg, to treat high blood pressure) but is best used for fissure treatment when compounded into a topical treatment and applied directly to the perianal skin. Topical treatment with 0.2 to 0.3% nifedipine two to four times a day has few side effects.

• #2 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  You can prevent an anal fissure, which is a tear in the tissue lining your anus, by taking steps not to get constipated. […] To help these fissures heal and keep them from coming back: Eat a healthy diet that has plenty of fiber. Stay well-hydrated. Avoid being constipated. […] Once you have an anal fissure, you’ll definitely want to avoid getting another one, so follow these simple steps. […] Get plenty of fiber. If you’re constipated, passing large, hard, or dry stools can cause an anal fissure. Getting plenty of fiber in your diet especially from fruits and vegetables can help prevent constipation, though. […] Stay hydrated. That can help you prevent constipation. Drinking plenty of liquids adds fluid to your system, which can make stools softer and easier to pass. […] Exercise. One of the most common causes of constipation is a lack of physical activity. Exercise for at least 30 minutes most days to help keep your digestive system moving and in good shape.

• #2 Anal Fissure Disease: Prevention and Quality of Life | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-49244-5_7

  Anal fissures have a tendency for recurrence or chronicity. Katsinelos et al. (2006) observed 16% recurrences, and Jensen et al. (1987) 25%. Therefore, strategies to avoid such developments should be designed. […] In a double-blind, placebo-controlled study concerning 90 patients with acute anal fissure, Jensen (1987) was able to prove that after the administration of 5 g of unprocessed bran (three times daily over a year), a recurrence affected only 16% of the cases. The placebo group, however, showed 68% recurrences. Bran absorbs four times its weight in water, and thus effects a voluminous stool which leads to a physiological dilatation of the anus during its passage. […] Contrary to bran, Plantago ovata (flee seed husks; Mucofalk) increases substantially in volume, so that its administration promises an even better therapeutic effect.

• #2 Anal fissure | UK Healthcare

  https://ukhealthcare.uky.edu/digestive-health-program/conditions/anal-fissure

  Minor anal fissures can often be helped to heal by drinking more fluids, eating a high-fiber diet, allowing enough time for a bowel movement, and using stool softeners. […] Avoid constipation: Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber. […] Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink. […] Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week. […] Take a fiber supplement, such as Benefiber or Metamucil, every day if needed. Read and follow all instructions on the label. […] Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement. But do not sit on the toilet for more than 10 minutes. […] Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position.

• #2 Anal Fissure Self-Care and Prevention

  https://www.verywellhealth.com/anal-fissures-home-remedies-4783633

  Home remedies for anal fissures include sitz baths, fiber supplements, stool softeners, and adequate hydration and fiber intake. […] It is important to keep stools soft and make it easier for them to pass out of the body so the fissure is not further irritated by bulk or straining. […] Treatment at home for uncomplicated anal fissures can include eating more fiber, using stool softeners, and drinking more water. […] If you’re prone to getting anal fissures, prevention is key. The measures used to treat an anal fissure may help in preventing one as well: Avoid straining during bowel movements. Try to consciously relax the muscles in the anal canal during a bowel movement. This can help you to avoid the increase in sphincter tone that may lead to fissures. […] Getting more fiber (through your diet or supplements), drinking more water, and using a stool softener can ease bowel movements. This can reduce the pain of having a bowel movement when you have a fissure and may even prevent future fissures.

• #2 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  Several lifestyle changes may help relieve discomfort and promote healing of an anal fissure, as well as prevent one from coming back. Changes include: […] Adding fiber to your diet. Eating about 25 to 35 grams of fiber a day can help keep stools soft and improve fissure healing. Fiber-rich foods include fruits, vegetables, nuts and whole grains. You also can take a fiber supplement. Adding fiber may cause gas and bloating, so increase your intake gradually. […] Drinking adequate fluids. Fluids help prevent constipation. […] Not straining during bowel movements. Straining creates pressure, which can open a healing tear or cause a new tear. […] Sitting in a warm bath. Also called a sitz bath, soaking in a warm-water bath for 10 to 20 minutes several times a day can soothe the skin and promote relaxation. If possible, take a sitz bath after bowel movements.

• #2 Anal Fissure | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116021/all/Anal_Fissure

  All measures to prevent constipation; avoid straining and prolonged sitting on toilet.

• #2 Anal Fissure

  https://healthhub.cpcmg.net/docs/anal-fissure

  Keep the stools soft and release them daily […] Cleanse the anus gently with warm water after passing stools.

• #2 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  Don’t ignore your urge to go. If your body tells you it’s time to have a bowel movement, don’t put it off till later. […] Practice healthy bathroom habits. These tips can help lessen constipation and strain on the anal canal. […] Ask your doctor about laxatives. If adding fiber to your diet and taking fiber supplements aren’t enough to treat constipation, laxatives may help. […] Avoid things that will irritate your skin. This includes scented soaps or certain kinds of bubble baths.

• #2 Anal Fissures Management and Treatment

  https://www.drsamratjankar.com/blogs/anal-fissures-management-and-treatment/

  Prevention of Anal Fissures […] – Fissures in infants: […] – Changing diapers frequently […] – Treat constipation immediately […] – Fissures in adults: […] – Keep your anorectal area dry […] – Wipe the area using soft materials, a cotton pad, or a moistened cloth. Do not use rough and scented toilet paper. […] – Promptly treat all constipation and diarrhea problems […] – Do not irritate the rectum […] – If you find yourself suffering from constant constipation or any other symptoms we mentioned, consult your doctor. The sooner you treat your problem, the better it is for you. […] – Use over-the-counter stool softeners to treat an anal fissure at home. […] – To stay hydrated and enhance digestion, drink more water. […] – Taking fiber supplements and eating more fibrous foods are two ways to improve your fiber intake. […] – To relax the anal muscles, reduce discomfort, and enhance blood flow to the anorectal area, take a sitz bath.

• #2 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  A high-fiber diet can help keep your stools regular and easily passable. This is a key factor in preventing future anal fissures. […] Eating a high-fiber diet, drinking plenty of fluids, taking sitz baths, and using anti-inflammatory ointments can help current fissures heal and prevent new ones. […] You cant always prevent anal fissures, but you can reduce your risk of getting one by taking the following preventive measures: keeping the anal area dry, cleansing the anal area gently with mild soap and warm water, drinking plenty of fluids, eating fibrous foods, and exercising regularly to avoid constipation, treating diarrhea immediately, changing infants diapers frequently if they have the condition.

• #2 Anal Fissures | Compounding Solutions Pharmacy & Wellness

  https://www.compoundsavannah.com/analfissures

  Change diapers frequently […] Treat constipation, if that is the cause […] Keep the anorectal area dry […] Wipe the area with soft materials, a moistened cloth, or cotton pad. Avoid using scented toilet paper. […] Promptly treat constipation and diarrhea […] Avoid irritating the rectum.

• #2 Anal Fissure | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/patient-care/cope-center/anorectal-disorders/anal-fissure/

  Maintain a high fiber diet (25-30 grams) You will be provided with a fiber information sheet. If you take a fiber supplement, it should be taken in the morning or afternoon (not before bed). Drink fiber supplements with plenty of fluids to reduce the chances of constipation. […] Sitz baths This is a method to provide pain relief and speed the healing of the fissure. This involves sitting in a warm bath or shower, directed at the anal area. These should be done two to three times a day for 10 to 15 minutes. These can also be used to clean the anal area after a bowel movement to avoid further irritation caused from using toilet paper. […] Bowel habits Avoid straining to have a bowel movement. The high-fiber diet should help soften the stool to make it easier to pass, reducing the need to strain. If increasing fiber does not soften the stool, try over-the-counter stool softeners (such as docusate sodium Colace) and/or laxatives (milk of magnesia, mineral oil, magnesium citrate, or Miralax preferred). Diarrhea can worsen the fissure.

• #2 Anal Fissure: Care Instructions | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.anal-fissure-care-instructions.uh3165

  Anal fissures can be prevented by avoiding constipation. […] Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber. […] Drink plenty of fluids. […] Get some exercise every day. Build up slowly to 30 to 60 minutes a day on 5 or more days of the week. […] Take a fiber supplement, such as Benefiber or Metamucil, every day if needed. […] Use the toilet when you feel the urge. Or when you can, schedule time each day for a bowel movement. A daily routine may help. […] Support your feet with a small step stool when you sit on the toilet. This helps flex your hips and places your pelvis in a squatting position. […] Your doctor may recommend an over-the-counter laxative, such as Miralax, Milk of Magnesia, or Ex-Lax. […] Use baby wipes or medicated pads, such as Preparation H or Tucks, instead of toilet paper to clean after a bowel movement. These products do not irritate the anus.

• #2 Anal Fissure | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/patient-care/cope-center/anorectal-disorders/anal-fissure/

  Pain medications Over-the-counter anti-inflammatory agents (example: Ibuprofen, Advil, Aleve, and Motrin) are the preferred medications to decrease inflammation and help with pain. Narcotic pain medications should be avoided because of the constipation they may cause, worsening the fissure. […] Cleansing Try to avoid toilet paper as this will further irritate the area. Instead use sitz-baths/showers or gentle cleansing with a moist wipe for sensitive skin. Avoid wipes with fragrance as they typically have alcohol and can irritate you skin. […] Lidocaine 2% jelly Lidocaine is a topical anesthetic that will numb the anal fissure, reducing symptoms. Lidocaine can be applied two to three times a day as needed. […] Nifedipine 0.2% ointment Nifedipine may be prescribed for chronic fissures to decrease anal sphincter spasm; it improves blood flow to the area, healing the fissure. It is applied twice daily and takes at least 4 to 6 weeks to be effective.

• #2 Anal Fissure – Milton Keynes University Hospital

  https://www.mkuh.nhs.uk/patient-information-leaflet/anal-fissure

  Anal fissures are common in both adults and children. […] If you keep the stools soft, and avoid getting constipated, it will help a fissure to heal and help to prevent it happening again. […] The best way to avoid a further fissure is not to become constipated by using the measures described above. That is, a high fibre diet, fluid, etc. […] Avoid painkillers that contain codeine such as cocodamol, as they are a common cause of constipation.

• #2 Anal Fissure

  https://healthlibrary.uwmedicine.org/Library/DiseasesConditions/Adult/Digestive/134,174

  An anal fissure is a tear in the tissue of the anus. […] The most common cause is large or hard stools because of constipation. […] A person is more at risk for an anal fissure if they have any of the below: Constipation that makes you strain to pass hard stool, A low-fiber diet, A lot of diarrhea, Recent weight loss surgery, if it leads to frequent diarrhea, Vaginal childbirth, Minor injury, such as from mountain biking, Any inflammatory condition of the anal area, Inflammatory bowel disease, Infection or HIV, Surgery, Other medical treatments that affect bowel movements or the anus. […] An acute anal fissure is one that lasts for a short time. It often heals within 6 weeks with simple treatment. It may heal when constipation is treated. […] Other treatments include: Changes in your diet. You may need to eat more fiber and drink more water to help ease diarrhea or constipation. It’s very important to treat constipation, or the fissure is likely to come back. […] To help prevent constipation or large or hard bowel movements: Get enough fiber in your diet. Drink enough water to stay well hydrated.

• #2 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  Practice anal sex carefully and it is best to use a lubricant. In this way, you protect the sensitive mucous membrane from injury. […] If you suspect you have an anal fissure, early detection is very important. This is the only way we can start treatment in time and avoid complications. Consult a doctor promptly and do not treat yourself for a long period of time with home remedies or with ointments recommended to you by medical laypersons.

• #2 Anal fissure – USZ

  https://www.usz.ch/en/disease/anal-fissure/

  You cannot prevent anal fissure in every case. Because sometimes doctors do not find a cause for it or anal fissure is the result of another disease. However, there are some factors that increase the risk of anal fissure and you can address these yourself. Examples are: […] Prevent constipation: Eat as balanced a diet as possible and consume plenty of fiber (e.g., whole grains, fruits, vegetables, legumes). Also, drink plenty of fluids. Recommended is at least 1.5 to 2 liters per day. Low-calorie drinks such as water, unsweetened tea or fruit juice spritzers are best. A soft stool lowers the risk of anal fissure. Even after anal fissure treatment, these tips are important to prevent a new fissure. Laxatives are then usually unnecessary otherwise talk to your doctor before taking them. […] Move a lot in everyday life and do sports. Exercise stimulates bowel activity. For example, take a walk after dinner, climb stairs instead of taking the elevator, or ride your bike to the supermarket instead of getting in your car. If you have a sedentary job, for example, in an office, it is best to try to move as much as possible even during working hours. Take the folder to your colleague yourself instead of putting it in the in-house mail, or stand up when you make phone calls. Exercise not only protects you from anal fissure, but also strengthens your overall well-being.

• #2 15 Steps to Prevent Anal Fissures Effectively

  https://www.nirvahealth.com/blog/steps-to-prevent-anal-fissures

  Fissure-in-ano or anal fissure is a health condition in the anal canal where there is a tear in the anal mucosa. This painful condition seen at the end part of your gut or intestines is caused by how healthy your gut is. Even though there are enough treatments for anal fissure, the best way to combat this recurring condition is prevention. […] Understanding your gut and how it works is the best way to prevent the occurrence of anal fissures. […] A diet rich in fibre promotes soft and smooth bowel movements. This prevents constipation and improves gut health. […] Intake of enough water helps keep the stools smooth and hydrated. Non-hydrated bowels make the stools hard and sharp, injuring the anal canal as they pass. […] Pushing or straining during bowel movements will injure your anal lining. Regularising your bowel timings is the best way to ensure you pass your stools without difficulty by letting them go off at their own pace and time.

• #2 Anal Fissures: Self-Care and Prevention

  https://www.health.com/anal-fissure-self-care-8679729

  Incorporating healthy habits into your daily routine that ensure regular, strain-free bowel movements can help prevent anal fissures. These include the following: […] Don’t strain during bowel movements. If you have difficulty passing stool, stay on the toilet for no longer than 10 minutes and try again later. Consider using a foot or squat stool to help achieve a more natural position for easier elimination. […] Eat plenty of fruits, vegetables, legumes, and whole grains to ensure a fiber-rich diet and help prevent constipation and hard stools. […] Moderate physical activity at least 3-4 times weekly helps prevent constipation. […] If you feel the urge to have a bowel movement, don’t delay or hold it in. […] Keep your anal area clean and dry. After bowel movements, gently clean the area with water (e.g., bidet), toilet paper, or wipes and pat dry. Avoid using hard soaps or wipes containing chemicals that can irritate the skin.

• #2 Anal fissure: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001130.htm

  To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently. […] Prevent hard stools and constipation by: […] Making dietary changes — eating more fiber or bulk, such as fruits, vegetables, and grains […] Drinking more fluids […] Using stool softeners. […] A sitz bath is a warm water bath used for healing or cleansing. Sit in the bath 2 to 3 times a day for 10 to 15 minutes each time. The water should cover only the hips and buttocks.

• #2 15 Steps to Prevent Anal Fissures Effectively

  https://www.nirvahealth.com/blog/steps-to-prevent-anal-fissures

  If you wear tight clothes around your waist and buttocks, it can contribute to anal discomfort and risk of anal fissures. […] A warm water sitz bath helps your anal muscles to relax and gives an improved blood flow. This helps in healing whatever cuts you have. […] You must follow good hygiene, dietetic rules, and anything that keeps your gut healthy. Regularising bowel movements is the first step to take to prevent recurrence of anal fissures. […] Yes, anal fissures are preventable. All you have to do is be mindful of your food and bowel habits. Apart from this, good toilet hygiene, clothing and gut health add to your prevention goals.

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