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Your Health Matters
Anal Fissures
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Anal fissures are cracks or tears in the skin around your anus. The crack in the skin exposes the
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
passage of a hard stool but also can be caused by persistent diarrhea.
Some people get fissures once in awhile. At times fissures can become chronic and last for years.
The pain of a fissure may cause people to avoid having a bowel movement, which may lead to
chronic constipation. People are often embarrassed to see a doctor about this because of the
location of the pain or they are afraid the treatment will cause more pain. Fissures leave a “tag” of
skin at the anal opening that people often mistake for a hemorrhoid.
Treatment
The fissure won’t heal without good blood supply, just like other wounds on the body. Unfortunately,
the spasm caused by the exposed muscle keeps blood away from the area, making it unlikely to heal.
Taking warm baths with the water up as high as your tub allows and relaxing the anal muscles will
allow blood to flow into the area. Most people have trouble knowing how to relax the muscle without
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
while you are in the tub. Take a bath three times a day and usually the fissure will heal within four weeks.
If you have a hard bowel movement during this time, you may recrack the healing skin. So it is
very important to increase the amount of fiber in your diet to ensure you have soft bowel
movements. You can do this by fiber-rich foods including raw fruits and vegetables and by
taking fiber supplements such as those listed below. The soluble fiber found in the prepared fiber
supplements will make your bowel movements soft and allow the fissure to heal.
You also must drink adequate amounts of fluid, up to eight glasses a day.
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Your doctor may prescribe ointments to help reduce the spasm and increase blood flow to the area.
Other ointments may be prescribed to reduce inflammation and pain.
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If your fissure does not heal in four weeks or you have had your fissure for a long time, you may need
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
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High-Fiber Diet and Supplemental Water
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A high-fiber diet along with supplemental water will help you have a soft, regular bowel movement.
The best time to have a bowel movement is when your body gives you the urge. This will minimize
problems with hemorrhoids, fissures, itching and other common colon, rectal and anal problems. A
diet high in fiber has about 25 to 30 grams of fiber per day. This can include both dietary fiber and
fiber supplements. Drink six to eight glasses of water each day to avoid worsening constipation from
the fiber.
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In general, the average content of dietary fiber per serving of each of the food groups is:
•Fruits and vegetables—1 to 3 grams
•Nuts—2 to 3 grams per ounce Beans (kidney,black, pinto, chickpeas), lentils;
most berries—4 to 6 grams
•White bread, white rice, refined pasta—less than 1 gram
•Unrefined grains such as bran, whole wheat bread, brown rice and barley are excellent sources of
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.
Fiber Supplements
Caution:
•Do not take if you have a narrowing in your esophagus or in your intestines
•If you are a diabetic, avoid the preparations with sugar
•If you need to watch your sodium (salt) intake, avoid the psyllium preparations
•If you are taking Tetracycline, avoid the polycarbophils
•If you have phenylketonuria, avoid the preparations with Aspartame
•If you are taking Coumadin, avoid the preparations with psyllium
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Types of Supplements:
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We recommend the powdered fiber supplements rather than the pill/capsules or crackers, because
they seem to work better. Be sure to drink six to eight glasses of water each day to avoid
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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Dose
Available forms
Form of fiber
Benefiber
One tablespoon per
day, maximum dose is 5
tablespoons per day.
Unflavored powder, nongritty, can be mixed with
fluids, or soft foods, or can
be used in cooked foods to
add extra fiber. It should not
be mixed with carbonated
beverages.
Soluble dietary fiber
extracted from the
seed of the cluster
bean. Each serving of
Benefiber provides 3
grams of soluble fiber
One teaspoon or one wafer
equals 3 grams of insoluble
fiber, 2 grams of soluble
fiber. Take up to three times
a day.
Flavored or non-flavored,
Psyllium, 3.4 grams
sweetened or artificially
sweetened, regular or
smooth. It comes in wafers,
including apple crisp &
cinnamon spice.
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Name
Metamucil
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Perdiem
Hydrocil
Instant
Konsyl
UniFiber
Citrucel
FiberCon
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Fiberall
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
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
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One tablespoon one to
three times daily.
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Please note: you can find fiber supplements other than these in health food stores or Trader Joe’s.
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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SDGEN0185 • Rev. 5/10
Physician Referral Service: 888/689-UCSF