PDF Anal Fissures

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PleAasneaol Fissures Anal fissures are cracks or tears in the skin around your anus. The crack in the skin exposes the

rde S muscle underneath causing burning and sharp pain when you have a bowel movement. The pain can

last for hours after the bowel movement and can be severe. These cracks are usually caused by the

r fr A passage of a hard stool but also can be caused by persistent diarrhea.

o Some people get fissures once in awhile. At times fissures can become chronic and last for years.

m M The pain of a fissure may cause people to avoid having a bowel movement, which may lead to

D chronic constipation. People are often embarrassed to see a doctor about this because of the o location of the pain or they are afraid the treatment will cause more pain. Fissures leave a "tag" of

cu P skin at the anal opening that people often mistake for a hemorrhoid. mentsLE Treatment

, The fissure won't heal without good blood supply, just like other wounds on the body. Unfortunately, M the spasm caused by the exposed muscle keeps blood away from the area, making it unlikely to heal.

e O Taking warm baths with the water up as high as your tub allows and relaxing the anal muscles will

d allow blood to flow into the area. Most people have trouble knowing how to relax the muscle without

ia a N first contracting or tensing it. So, while you are in the tub, contract the muscle you use to stop having

a bowel movement or to urinate. Then concentrate on relaxing that muscle. Do this every five minutes

n while you are in the tub. Take a bath three times a day and usually the fissure will heal within four weeks.

d M L If you have a hard bowel movement during this time, you may recrack the healing skin. So it is a Y very important to increase the amount of fiber in your diet to ensure you have soft bowel

i movements. You can do this by fiber-rich foods including raw fruits and vegetables and by l: taking fiber supplements such as those listed below. The soluble fiber found in the prepared fiber 41 supplements will make your bowel movements soft and allow the fissure to heal. 5/ You also must drink adequate amounts of fluid, up to eight glasses a day. 51 Your doctor may prescribe ointments to help reduce the spasm and increase blood flow to the area. 4 Other ointments may be prescribed to reduce inflammation and pain. -20 If your fissure does not heal in four weeks or you have had your fissure for a long time, you may need 54 surgery. The surgeon will cut a small portion of the anal sphincter to reduce the constriction and help

reduce the spasm. The procedure is called an Internal Sphincterotomy. This surgery usually causes very little discomfort, and the fissure then can heal. This is an outpatient procedure, so you may go home the same day. Some people who have this operation leak gas or stool.

Physician Referral Service: 888/689-UCSF

Occasionally, Botox A injections are an alternative to sphincterotomy in patients who do not heal in the expected time frame. Botox blocks the signals from the nerve and relaxes the anal sphincter muscle. Because the sphincter does not tighten or contract as much as before, the fissure has an increased chance of healing. Some people who have this procedure leak gas or stool, but this is temporary. The Botox effect wears off in about three months.

Fiber

P High-Fiber Diet and Supplemental Water leA high-fiber diet along with supplemental water will help you have a soft, regular bowel movement. as The best time to have a bowel movement is when your body gives you the urge. This will minimize e problems with hemorrhoids, fissures, itching and other common colon, rectal and anal problems. A o diet high in fiber has about 25 to 30 grams of fiber per day. This can include both dietary fiber and

rde S fiber supplements. Drink six to eight glasses of water each day to avoid worsening constipation from

the fiber.

r fr A In general, the average content of dietary fiber per serving of each of the food groups is: om M ? Fruits and vegetables--1 to 3 grams

D ? Nuts--2 to 3 grams per ounce Beans (kidney,black, pinto, chickpeas), lentils; o most berries--4 to 6 grams

cu P ? White bread, white rice, refined pasta--less than 1 gram me L ? Unrefined grains such as bran, whole wheat bread, brown rice and barley are excellent sources of nts E fiber. Read the label on the package to know the amount available in each product. Bulgar, barley,

quinoa, oatmeal and bran cereals have between 3 and 6 grams per half cup.

, Me O Fiber Supplements

d Caution:

ia a N ? Do not take if you have a narrowing in your esophagus or in your intestines nd L ? If you are a diabetic, avoid the preparations with sugar Ma Y ? If you need to watch your sodium (salt) intake, avoid the psyllium preparations

il ? If you are taking Tetracycline, avoid the polycarbophils : 41 ? If you have phenylketonuria, avoid the preparations with Aspartame 5/ ? If you are taking Coumadin, avoid the preparations with psyllium 514 Types of Supplements: -20 We recommend the powdered fiber supplements rather than the pill/capsules or crackers, because 5 they seem to work better. Be sure to drink six to eight glasses of water each day to avoid 4 constipation. It helps to start with a rounded teaspoon for a week and then slowly increase to

heaping tablespoon. You can take more or less until your stools are spongy.

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Name

Dose

Available forms

Form of fiber

Benefiber

One tablespoon per

Unflavored powder, non- Soluble dietary fiber

day, maximum dose is 5 gritty, can be mixed with extracted from the

tablespoons per day.

fluids, or soft foods, or can seed of the cluster

be used in cooked foods to bean. Each serving of

add extra fiber. It should not Benefiber provides 3

PleMetamucil

ase order frSA Fiberall om DoM Perdiem cumePntsLE Hydrocil

, Instant

Me O Konsyl dia a N UniFiber nd M L Citrucel ail: 4Y15/5 FiberCon

be mixed with carbonated grams of soluble fiber beverages.

One teaspoon or one wafer Flavored or non-flavored,

equals 3 grams of insoluble sweetened or artificially

fiber, 2 grams of soluble sweetened, regular or

fiber. Take up to three times smooth. It comes in wafers,

a day.

including apple crisp &

cinnamon spice.

Psyllium, 3.4 grams

One tablespoon equals

Flavors include orange

2 grams soluble fiber and and tropical fruit as well as

1.5 grams of insoluble fiber. sugar-free.

One teaspoon equals 4 grams of psyllium. Take up to 1 to 2 teaspoons four times a day.

Mint flavored

Psyllium 3.25 grams (stimulant)

One teaspoon equals 3.5 grams of psyllium

Psyllium

One teaspoon equals 6 grams of psyllium.

Psyllium

One teaspoon equals 3 grams of cellulose.

Cellulose

One tablespoon one to three times daily.

Orange-flavored, sugar-free Methylcellulose, powder equals 2 grams per tablespoon

One caplet equals 500 mg of polycarbophil. Take one to four caplets a day.

Caplet

Calcium polycarbophil

14-20 Please note: you can find fiber supplements other than these in health food stores or Trader Joe's. 54 Many chain stores such as Walgreens, CVS or Costco have their own brand of fiber supplements,

which work well and may be more affordable. Some cereals also have added fiber, so check the labels.

Center for Colorectal Surgery at UCSF (415) 885-3606

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SAM Please order from PLE ONLY Documents, Media and Mail: 415/514-2054

SDGEN0185 ? Rev. 5/10

Physician Referral Service: 888/689-UCSF

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